hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|MD,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,,,,,,,,,,,,,,,,,,
Johns Hopkins Bayview Medical Center,4/1/2026,3.0.0,Johns Hopkins Bayview Medical Center,"4940 Eastern Avenue, Baltimore, MD 21224",1790700904,30005,TRUE,Ed Beranek,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,modifiers,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4441.84,4441.84,4441.84,1 through 10,percent of total billed charges,,,
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2865.52,2865.52,2865.52,1 through 10,percent of total billed charges,,,
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2091.82,2091.82,2091.82,1 through 10,percent of total billed charges,,,
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1950.89,1950.89,1950.89,1 through 10,percent of total billed charges,,,
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Endo, single, pulmonary",2042,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,126.31,114.7,359.06,2926,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,134.17,125.08,423.09,3955,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,132.22,98.09,334.63,9865,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,134.16,104.76,405.34,15498,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,178.12,68.92,2754.82,12,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,120.81,74.25,274.46,264,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,134.16,119.51,442.26,408,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,161.47,96.88,535.44,52,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,134.16,125.08,384.55,4968,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,174.33,116.32,417.57,4488,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,123.83,111.51,309.58,3931,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,127.63,127.63,375.5,48,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,123.83,95.6,384.45,349,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,120.2,115.99,338.04,6193,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,119.94,114.61,414.44,44,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,124.18,113.79,376.96,1512,percent of total billed charges,,,
Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,134.17,126.35,383.43,2715,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,98.29,25.68,373.03,15,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,161.62,108.45,601.78,20,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,161.62,59.05,417.47,32,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,148.23,1.48,310.37,74,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,148.74,142.2,349.21,55,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,119.85,110.14,275.45,1 through 10,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,148.17,148.17,148.17,1 through 10,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,142.54,37.52,8610.54,1 through 10,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,158.38,57.45,405.21,19,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,145.01,140.12,648.69,1 through 10,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,152.02,132.9,620.84,1 through 10,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,157.58,157.58,157.58,1 through 10,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,147.67,37.52,1182.58,12,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,143.33,139.03,274.67,433,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,146.6,141.51,251.76,121,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,137.74,37.52,180.28,17,percent of total billed charges,,,
Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,161.62,42.02,390.01,18,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,522.86,300.36,2156.29,1 through 10,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,315.4,211.22,615.91,33,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,320.74,167.89,830.64,73,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,331.58,158.27,824.1,130,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,293.2,144.27,551.15,81,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,232.51,220.29,275.36,1 through 10,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,311.63,311.63,533.07,1 through 10,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,352.48,187.53,845.14,18,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,319.83,166.31,777.36,53,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,321.49,74.23,706.88,24,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,275.37,191.83,1320.66,1 through 10,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,437.93,437.93,437.93,1 through 10,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,431.14,191.83,1387.64,1 through 10,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,282.12,141.06,549.69,1008,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,293.2,146.6,598.46,177,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,273.13,175.08,480.07,21,percent of total billed charges,,,
Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,320.01,176.5,800.49,24,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,594.75,298.42,1228.92,110,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,767.22,439.49,1630.2,80,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,569.03,325.85,1471.9,296,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,538.88,69.25,1216.92,374,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,545.07,146.6,958.08,199,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,598.25,386.65,1570.27,12,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,825.26,677.81,2118.32,1 through 10,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,669.2,335.22,1661.55,23,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,581.15,379.97,1199.36,197,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,556.39,228.75,1622.73,76,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,693.06,417.95,1921.47,47,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,478.48,457.02,861.3,1 through 10,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,531.28,341.67,1287.06,48,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,437.05,141.06,826.97,2094,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,500.54,189.14,906.18,307,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,541.24,330.42,1263.78,95,percent of total billed charges,,,
Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,527.76,212.79,1448.05,124,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1152.35,751.17,2144.22,163,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1260.99,810.2,3651.53,160,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1166.81,693.11,2474.29,405,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1107.81,513.2,2431.32,570,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1108.11,751.54,2468.81,198,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1092.83,648.17,4442.16,49,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1042.36,763.4,3071.61,27,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1013.13,630.58,2828.78,65,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1160.13,582.26,2681.1,247,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1088.94,688.59,2779.12,158,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1163.45,773.96,3342.44,112,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,2072.09,2072.09,2072.09,1 through 10,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1053.3,655.85,3029.77,66,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1040.88,145.42,2254.94,1265,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1057.08,575.37,1934.51,260,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1085.57,744.05,2751.65,183,percent of total billed charges,,,
Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,998.06,349.8,2038.31,173,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2016.97,1430.81,6533.2,126,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1956.71,1337.57,4421.7,120,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1991.67,1178.65,4312.25,313,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1896.43,1122.67,4699.39,442,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1960.13,1152.37,3970.38,139,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1746.59,1159.29,4464.88,38,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,2199.63,1731.56,4596.47,13,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1714.29,1320.81,4428.04,74,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2052.78,1294.71,4628.64,227,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1860.37,1230.99,3776.24,158,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1985.26,1347.66,4144.36,110,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,2076.57,1940.36,3734.45,1 through 10,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1775.95,1331.78,3681.12,95,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1875.7,1337.6,3408.71,795,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1826.31,1163.62,4062.25,175,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1898.3,1277.57,4014.86,221,percent of total billed charges,,,
Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1804.32,569.79,4084.97,160,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,441.83,113.97,1572.67,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,130.63,130.63,130.63,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,428.56,315.67,2901.17,25,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,370.4,93.7,738.03,29,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,133.7,128.48,441.82,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,396.63,90.87,1022.56,11,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,81.97,81.97,94.21,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,381.82,381.82,659.55,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,383.96,329.02,567.76,21,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,368.13,368.13,368.13,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,688.15,381.01,866.82,1 through 10,percent of total billed charges,,,
Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,842.06,188.45,1420.23,15,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,656.71,401.2,4426.22,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,547.26,180.68,2387.01,25,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,458.33,103.42,2340.65,50,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,370.46,370.46,370.46,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,235.76,223.04,1230.77,14,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,422.33,422.33,422.33,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2896.53,412.96,4666.88,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,99.58,99.58,99.58,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,211.21,192.21,4490.51,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,516.98,516.98,516.98,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1209.64,672.97,3793.98,1 through 10,percent of total billed charges,,,
Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,235.08,188.63,921.59,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,913.73,779.41,2908.16,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,5252.59,5252.59,5252.59,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1222.7,841,15431.92,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1040.89,783.16,3825.4,11,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2730.4,1055.53,3779.04,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3710.85,3523.87,8514.89,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6258.93,6258.93,6258.93,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2029.17,1621.74,14976.06,1 through 10,percent of total billed charges,,,
Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,12473.65,12473.65,12473.65,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2863.14,906.83,8832.58,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4634.69,783.05,20490.38,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,5904.65,5904.65,5904.65,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,11062.25,7430.08,18334.01,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,5699.55,5699.55,5699.55,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6792.26,4580.69,14987.27,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2728.55,2728.55,2728.55,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11702.01,11702.01,16592.17,1 through 10,percent of total billed charges,,,
Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,6228.74,6228.74,6228.74,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13191.86,6812.53,15862.17,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,13447.99,10921.78,19805.1,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,10860.63,6977.72,22420.8,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,15000.71,15000.71,15000.71,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13483.92,13483.92,13483.92,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7809.47,7809.47,14157.6,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11889.85,11472.61,15974.93,1 through 10,percent of total billed charges,,,
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4681.15,4681.15,4681.15,1 through 10,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2871.1,1897.62,6042.33,1 through 10,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3783.08,2107.25,6812.87,44,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,3364.91,1404.63,6123.79,50,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,5849.85,5394.61,7449.4,1 through 10,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,4073.21,2107.98,5253.97,11,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,3469.16,1844.16,7145.54,17,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,3554.2,2548.65,7511.76,1 through 10,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1250.47,1250.47,1250.47,1 through 10,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4036.02,2133.71,5732.09,17,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2647.54,2647.54,4047.19,1 through 10,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3497.95,1562.07,6148.25,13,percent of total billed charges,,,
Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4167.23,4144.39,6350.39,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,4102.58,2520.95,8442.92,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3733.13,1512.37,6483.16,16,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4816.31,1857.07,9707.03,40,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,8999.51,8999.51,8999.51,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,4387.21,3442.68,7084.96,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,3133.26,2131.52,7080.04,17,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4845.16,3073.15,6580.41,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3263.49,2442.03,7002.13,12,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3629.73,3629.73,3629.73,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,9718.15,3854.17,10628.42,1 through 10,percent of total billed charges,,,
Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8796.46,8796.46,8796.46,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,12941.67,4319.77,18236.74,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7717.15,4679.88,20491.42,14,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,8617.92,6692.45,13629.65,16,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,5430.09,5430.09,5430.09,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,4594.8,4594.8,4594.8,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,5561.69,89.63,11954.07,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4190.3,3828.65,10689.97,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,12537.62,12537.62,12537.62,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5517.76,3294.01,11337.77,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,12767.28,4745.49,17850.22,1 through 10,percent of total billed charges,,,
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7686.99,7618.2,7690.85,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,6327.61,6327.61,11387.83,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5956.55,5021.62,11047.23,11,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,6664.98,5306.29,13575.36,26,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,9434.26,9434.26,9434.26,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,9046.04,5412.1,14214.25,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,9519.56,5891.68,14596.8,11,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6431.48,4841.07,8309.79,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7280.23,4462.43,8581.68,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9614.83,9614.83,9614.83,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11435.27,11435.27,11435.27,1 through 10,percent of total billed charges,,,
Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19424.8,19424.8,19424.8,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,18447.07,15358.15,26639.72,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,26070.2,16967.89,32606.07,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,19674.87,12778.26,24170.06,11,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,15055.45,14619.16,37176.22,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,20372.59,20372.59,20372.59,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10361.94,10361.94,10361.94,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,19783.3,13311.02,21925.59,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,11799.87,11799.87,11799.87,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,24369.11,24369.11,24369.11,1 through 10,percent of total billed charges,,,
Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,29051.88,29051.88,29051.88,1 through 10,percent of total billed charges,,,
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,90304.87,90304.87,90304.87,1 through 10,percent of total billed charges,,,
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,26201.77,26201.77,26201.77,1 through 10,percent of total billed charges,,,
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,39542.74,39542.74,39542.74,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,38488.5,35561.74,58028.83,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,37223.85,37223.85,46087.67,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,52586.27,52586.27,52586.27,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,30687.65,30687.65,30687.65,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,25295.88,25295.88,25295.88,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,34494.03,34494.03,34494.03,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,27977.67,27977.67,27977.67,1 through 10,percent of total billed charges,,,
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,377.58,240.97,410.76,15,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,358.2,11.66,955.65,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,737.95,398.9,1667.57,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,499.66,499.66,499.66,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1042.86,992.38,1042.86,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,705.82,443.24,984.12,15,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,260.15,255.8,461.21,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,240.97,204.34,664.08,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,225.64,225.64,225.64,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,396.61,230.23,999.75,12,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,439.46,439.46,439.46,1 through 10,percent of total billed charges,,,
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,429.13,429.13,429.13,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,681.76,381.24,865.22,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,396.51,282.42,900.97,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,415.15,178.44,613.09,13,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,509.03,297.32,745.03,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,253.53,250.99,529.59,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,252.66,155.13,414.25,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,210.92,210.92,210.92,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,385.33,192.9,798.68,25,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,379.18,379.18,379.18,1 through 10,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,221.85,80.02,275.82,11,percent of total billed charges,,,
Level 2 Strapping and Cast Application,5102,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6275.67,6275.67,6275.67,1 through 10,percent of total billed charges,,,
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,442.22,442.22,442.22,1 through 10,percent of total billed charges,,,
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,500,500,500,1 through 10,percent of total billed charges,,,
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,3938.71,3938.71,3938.71,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,3284.44,3284.44,3284.44,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3168.92,1549.5,4494.45,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,3055.28,1767.1,9953.71,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3394.82,3113.83,3719.16,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2312.27,1988.32,6368.47,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2275.27,2246.85,3275.08,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1607.54,1607.54,4043.98,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2675.27,2675.27,2675.27,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1526.5,1526.5,4664.37,1 through 10,percent of total billed charges,,,
Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16810.04,16810.04,16810.04,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,6258.98,4222.3,24053.67,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6505.06,4780.05,12543.5,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,5363.33,4510.69,12201.29,11,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,2204.18,2204.18,2204.18,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,2451.55,2451.55,2451.55,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,8274.44,4900.21,13532.23,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,5253.42,428.56,10478.45,15,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6925.68,6497.7,9246.89,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6095.72,2701.13,15200.9,17,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6289.94,6289.94,6289.94,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,9762.65,4275.97,29716.52,1 through 10,percent of total billed charges,,,
Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,17397.52,17397.52,17397.52,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,19569.29,18414.44,35430.08,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15841.67,8240.63,28308.59,21,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,21119.14,15357.12,24948.13,25,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,24215.14,24215.14,24215.14,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,20931.24,20931.24,20931.24,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,17627.41,13127.16,31321.38,18,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,19623.41,15004.16,26376.05,12,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10556.83,10556.83,23682.32,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,29606.36,29606.36,29606.36,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,20717.26,20717.26,20717.26,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15759.58,14394.89,23266.23,12,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,44485.8,44485.8,44485.8,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19876.94,16342.31,37379.56,1 through 10,percent of total billed charges,,,
Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,19259.26,15816.22,28190.62,16,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,17510.81,14512.9,24766.38,17,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17069.14,14922.87,28202.05,46,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,17867.32,13933.25,25686.2,52,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,25838.23,25838.23,25838.23,1 through 10,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,17095.28,16562.54,22753.62,1 through 10,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,17948.94,15892.78,29950.5,20,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,16439.78,14591.79,23833.86,34,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,15942.72,13434.2,19294.91,26,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,14323.8,14323.8,25162.19,1 through 10,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,17760.79,14504.69,35213.11,18,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,14530.36,12560.41,17288.68,1 through 10,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,17313.9,13570.91,32630.44,1 through 10,percent of total billed charges,,,
Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,57549.27,57549.27,57549.27,1 through 10,percent of total billed charges,,,
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,50235.51,50235.51,50235.51,1 through 10,percent of total billed charges,,,
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,54482.51,54482.51,54482.51,1 through 10,percent of total billed charges,,,
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,71695.08,71695.08,71695.08,1 through 10,percent of total billed charges,,,
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,561.13,276.97,576.75,13,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,528.49,528.04,954.65,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,508.42,173.05,646.78,41,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,366.3,172.43,626.62,63,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,517.92,517.92,517.92,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,280.02,280.02,626.86,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,339.98,129.47,541.63,34,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,503.73,170.7,559.7,23,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,164.48,149.75,1838.66,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,175.76,175.76,175.76,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,130.17,130.17,130.17,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,168.68,153.47,464.06,40,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,264.24,264.24,264.24,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,340.67,340.67,340.67,1 through 10,percent of total billed charges,,,
Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,761.53,682.3,3616.48,15,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,677.24,649.1,2776.94,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,762.13,702.97,2094.3,35,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,761.52,649.29,2341.1,79,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,703,702.9,1076.07,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,717.24,717.24,717.24,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,761.53,661.42,2426.95,23,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,758.83,653.06,759.59,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,341.77,322.52,1335.5,14,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,656.85,351.45,706.48,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,682.27,617.45,682.27,23,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,678.38,622.36,2231.55,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2427.64,900.2,3653.37,1 through 10,percent of total billed charges,,,
Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,3823.73,3586.48,4549.13,1 through 10,percent of total billed charges,,,
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2923.96,2923.96,5269.65,1 through 10,percent of total billed charges,,,
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4288.35,862.72,5796.41,1 through 10,percent of total billed charges,,,
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,4301.47,4301.47,4669.4,1 through 10,percent of total billed charges,,,
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2999.41,2999.41,2999.41,1 through 10,percent of total billed charges,,,
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3062.7,3062.7,3062.7,1 through 10,percent of total billed charges,,,
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6750.01,6750.01,6750.01,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,4527.01,4159.31,11340.86,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6434.06,3727.8,8989.63,21,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,7550.31,4672.85,9600.53,39,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,13580.05,13580.05,13580.05,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,6656.41,4712.55,9330.7,16,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,6610.74,4847.94,9529.62,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,5951.19,5444,5997.2,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,2680.01,2680.01,2680.01,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6125.33,4162.83,9189.81,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5892.78,5892.78,12954.95,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,5511.4,3838.97,8644.64,1 through 10,percent of total billed charges,,,
Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6882.84,6882.84,6882.84,1 through 10,percent of total billed charges,,,
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15968.71,15968.71,19673.4,1 through 10,percent of total billed charges,,,
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,17353.26,17353.26,17353.26,1 through 10,percent of total billed charges,,,
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,25000.3,25000.3,25000.3,1 through 10,percent of total billed charges,,,
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10722.05,10722.05,15070.94,1 through 10,percent of total billed charges,,,
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10321.77,9113.04,10944.53,1 through 10,percent of total billed charges,,,
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4435.68,4226.99,8118.1,1 through 10,percent of total billed charges,,,
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,9563.98,9563.98,9563.98,1 through 10,percent of total billed charges,,,
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,693.68,693.68,693.68,1 through 10,percent of total billed charges,,,
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9563.7,9563.7,9563.7,1 through 10,percent of total billed charges,,,
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7973.94,7973.94,7973.94,1 through 10,percent of total billed charges,,,
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,897.86,273.95,1374.12,1 through 10,percent of total billed charges,,,
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,312.27,312.27,312.27,1 through 10,percent of total billed charges,,,
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,666.69,666.69,666.69,1 through 10,percent of total billed charges,,,
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,555.59,555.59,5711.57,1 through 10,percent of total billed charges,,,
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,970.56,970.56,970.56,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1640.63,1640.63,2327.45,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1208.05,724.76,2368.8,13,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1351.44,1351.44,2351.12,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2044.02,1957.21,2489.16,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,322.7,322.7,322.7,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,2249.26,2249.26,2249.26,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1671.44,377.78,2143.62,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1786.24,1786.24,1786.24,1 through 10,percent of total billed charges,,,
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1622.95,1622.95,1622.95,1 through 10,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,6399.28,5939.47,7848.41,1 through 10,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4820.35,3867.54,8045.59,1 through 10,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,5879.01,3098.46,17729.71,1 through 10,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3702.52,3531.63,4976.81,1 through 10,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4426.73,4426.73,4426.73,1 through 10,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4903.27,3712.94,6240.92,14,percent of total billed charges,,,
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,18866.12,18866.12,18866.12,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4802.09,4164,5592.72,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,5349.05,4538,31648.47,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,4814.74,4605.45,6787.07,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,6003.25,6003.25,6260.63,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17399.02,17399.02,17399.02,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4938.4,726.6,7312.77,35,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6444.85,6444.85,6444.85,1 through 10,percent of total billed charges,,,
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2758.01,2758.01,2758.01,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2642.09,2642.09,2642.09,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2621.72,2621.72,2621.72,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2057.75,1299.39,2439.51,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,4316.3,4316.3,4316.3,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,120.33,120.33,120.33,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2064.75,2064.75,2064.75,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1304.5,1304.5,1304.5,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,324.5,324.5,324.5,1 through 10,percent of total billed charges,,,
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1644.68,871.42,4184.89,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,3199.71,3199.71,3199.71,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2020.23,1565.89,4349.41,11,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2563.21,1664.17,5212.09,14,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1419.89,1419.89,1419.89,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2383.99,1751.9,7078.15,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2964.92,2964.92,6365.49,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2198.96,1963.48,11772.11,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2981.55,2981.55,2981.55,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7817.04,7817.04,7817.04,1 through 10,percent of total billed charges,,,
Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,6478.09,6478.09,8038.4,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6546.13,5028.95,99992.76,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7224.28,3576.6,10466.41,28,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,7660.24,5110.77,12095.47,28,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,221.08,221.08,221.08,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,7209.37,7209.37,7209.37,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,7454.97,7454.97,7454.97,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,9406.06,4664.83,10304.16,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,5057.38,3291.16,8162.18,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6444.01,5132.07,53515,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,6471.85,6471.85,7775.6,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7565.97,6567.96,12062.66,12,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,12857.82,12857.82,12857.82,1 through 10,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7265.02,3698.64,8957.53,11,percent of total billed charges,,,
Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6432.32,3148.26,15336.25,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7878.45,4995.62,19464.95,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,8447.77,6624.66,16797.58,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11349.79,6320.42,18496.07,21,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,9058.85,6101.43,18361.91,44,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,8007.9,6354.07,23215.61,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,8558.27,8163.24,12995.35,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6690.9,5335.88,12013.81,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11203.23,7374.86,14678.07,11,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5736.72,5736.72,14078.17,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13022.47,13022.47,13022.47,1 through 10,percent of total billed charges,,,
Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,5093.88,5093.88,5093.88,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6462.21,4702.84,13975.9,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4979.47,4187.53,11808.44,14,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,6141.03,3754.49,10851.04,25,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,7654.94,7654.94,7654.94,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,6158.74,5177.23,11527.18,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,3254.78,3254.78,3593.92,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1774.85,1111.31,5349.19,11,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4420.14,4305.28,8969.9,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4607.96,4033.64,8231.8,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,5788.12,5788.12,8162.82,1 through 10,percent of total billed charges,,,
Level 1 Endovascular Procedures,5191,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,28670.72,28670.72,28670.72,1 through 10,percent of total billed charges,,,
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,12102.17,12102.17,12102.17,1 through 10,percent of total billed charges,,,
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,12374.17,12374.17,12374.17,1 through 10,percent of total billed charges,,,
Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16853.48,16853.48,16853.48,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,17846.28,17846.28,17846.28,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,16359.36,13391.82,20550.4,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,20334.32,10221.53,24686.3,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,32182.39,32182.39,32182.39,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,17181.02,17181.02,17181.02,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14939.51,14939.51,23249.33,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9759.6,9759.6,9759.6,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9459.82,9459.82,9459.82,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,25389.63,25389.63,25389.63,1 through 10,percent of total billed charges,,,
Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20157.69,20157.69,20157.69,1 through 10,percent of total billed charges,,,
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1847.37,1574.25,6354.29,13,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1147.74,1147.74,1147.74,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1816.89,1067.96,5561.83,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2346.36,1182.81,26106.87,17,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1455.02,746.46,1601.13,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,23268.61,23268.61,23268.61,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,23314.08,23314.08,23314.08,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2382.61,1087.85,22661.51,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2380.66,2380.66,2380.66,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1299.3,1069.43,4005.74,1 through 10,percent of total billed charges,,,
Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2191.36,1359.08,5641.78,45,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4351.24,2388.35,6768.35,28,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3477.86,1430.52,7126.68,124,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2800.01,1446.29,6302.14,145,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1003.88,1003.88,1003.88,1 through 10,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3906.53,1482.37,8448.32,64,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2710.32,1437.13,6668.47,42,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1465.21,1070.03,3570.78,23,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,4972.64,4972.64,4972.64,1 through 10,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,4458.55,4458.55,4458.55,1 through 10,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1715.51,1132.45,6172.77,78,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3307.76,3307.76,3307.76,1 through 10,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1780.57,1334.87,6624.98,15,percent of total billed charges,,,
Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2612.22,1236.37,6987.05,29,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,3122.34,2361.3,3915.29,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2614.54,1596.14,3546.26,11,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3174.18,2066.24,5538.2,22,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,3062.78,2037.97,4585.63,32,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,2478.41,2478.41,2478.41,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3633.37,1574.78,6651.16,18,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,3426.43,1725.99,3758.3,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2777.47,1963.33,14568.24,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,2808.79,2808.79,2808.79,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,2834.9,2834.9,2834.9,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2435.72,1615.99,4060.61,11,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2953.06,1845.83,5227.24,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3174.1,2070.96,4728.73,1 through 10,percent of total billed charges,,,
Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7911.45,7911.45,7911.45,1 through 10,percent of total billed charges,,,
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,5781.34,5781.34,5781.34,1 through 10,percent of total billed charges,,,
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13928.86,13928.86,13928.86,1 through 10,percent of total billed charges,,,
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,11415.38,11415.38,11415.38,1 through 10,percent of total billed charges,,,
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4487.2,4487.2,4487.2,1 through 10,percent of total billed charges,,,
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4635.82,4635.82,4735.03,1 through 10,percent of total billed charges,,,
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2162.13,1604.81,4451.26,15,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2216.9,1981.85,3297.09,12,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2484.81,1689.32,3791.65,53,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2225.56,1587.77,4007.07,77,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,3301.3,3301.3,3301.3,1 through 10,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,2424.18,2424.18,2424.18,1 through 10,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1867.07,1867.07,1867.07,1 through 10,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2413.69,1942.2,3513.43,22,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2750.66,1687.75,4973.12,32,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1503.2,217.77,3407.89,15,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,1869.43,1869.43,1869.43,1 through 10,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1870.86,1399.81,4315.69,20,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1887.01,1887.01,1887.01,1 through 10,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2298.94,1952.86,4290.22,13,percent of total billed charges,,,
Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2899.83,2028.1,4858.07,51,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,3180.12,2193.98,5611.51,30,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3338.63,2191.77,5482.93,100,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,3115.88,2111.86,5786.81,142,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,3208.37,3208.37,3208.37,1 through 10,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,3805.71,3805.71,3805.71,1 through 10,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,3225.48,3225.48,3225.48,1 through 10,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3154.38,2122.69,5030.37,41,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,3104.82,2139.99,6145.07,51,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2913.68,1879,4875.33,41,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,4526.02,3285.86,4907.69,1 through 10,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3302.06,2180.46,5991.79,43,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2423.93,1918.31,5506.85,20,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3006.54,1954.74,4725.93,29,percent of total billed charges,,,
Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2440.46,2440.46,2440.46,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4256.76,4006.2,7921.16,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4902.88,3013.95,9903.24,19,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4213.39,2868.18,7169.2,22,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,5817.63,4310.22,30811.61,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4007.52,3768.54,6114.19,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4850.57,4193.05,5836.19,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4009.47,4009.47,4225.56,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3224.42,2903.65,9796.27,1 through 10,percent of total billed charges,,,
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10217.17,10217.17,10217.17,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,9811.22,9811.22,9811.22,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7529.08,7529.08,9373.45,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,8283.64,8283.64,9033.98,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,7280.15,7136.55,11137.71,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,6581.97,6581.97,6581.97,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7330.36,6253.94,9470.23,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5855.5,5855.5,5855.5,1 through 10,percent of total billed charges,,,
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,9516.44,6075.61,26062.24,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6358.96,4997.13,14757.7,14,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,8601.07,4243,11782.76,18,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,8708.01,6500.76,22999.87,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,12339.16,4775.37,14117,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6805.79,6478.7,11859.79,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6039.23,6039.23,6039.23,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7111.69,7111.69,7111.69,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,8490.12,4889.09,11170.45,1 through 10,percent of total billed charges,,,
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7994.18,7994.18,7994.18,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,16705.1,16705.1,16705.1,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,21226.66,21226.66,23071.95,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,18999.1,6125.93,21172.29,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,8693.96,8693.96,8693.96,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,33820.14,33820.14,33820.14,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13036.47,13036.47,13036.47,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22095.34,22095.34,22095.34,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19357.32,19357.32,19357.32,1 through 10,percent of total billed charges,,,
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,14259.72,8077.19,24651.06,27,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12852.2,12852.2,12852.2,1 through 10,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,12869.03,8221.23,18406.05,52,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,13487.46,9421.45,19710.14,72,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,15942.36,15942.36,15942.36,1 through 10,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,15306.71,9371.85,23787.02,35,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,11673.81,7838.76,17628.68,26,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13341.27,9690.85,14565.68,1 through 10,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,22535.28,22535.28,22535.28,1 through 10,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11499.17,8128.58,16417.31,64,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,12779.58,12779.58,12779.58,1 through 10,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,18916.74,18916.74,18916.74,1 through 10,percent of total billed charges,,,
Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11014.4,8186.84,17088.86,18,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,20860.65,19182.92,21374.83,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,19539.95,16690.68,28110.19,17,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,20637.7,17033.9,27745.59,28,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,18837.56,13592.24,25510.25,77,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,12568.86,12568.86,12568.86,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,23775.87,23775.87,23775.87,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,20452.45,14575.34,25612.95,11,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,19659.1,11897.5,29199.18,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,18573.51,18573.51,18591.29,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,19390.79,19390.79,19390.79,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15643.12,14229.59,24213.8,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,18588.35,18588.35,18588.35,1 through 10,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19031.17,15610.25,24620.88,23,percent of total billed charges,,,
Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,133.83,43.15,141.21,18,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,123.52,118.59,130.34,68,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,117.73,84.83,158.21,25,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,133.83,85.78,189.31,71,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,124.79,124.79,4064.63,1 through 10,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,37.05,37.05,37.05,1 through 10,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,139.8,128.48,2360.77,13,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,125.5,125.5,125.5,1 through 10,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,115.17,82.04,365.6,19,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,129.68,129.68,129.68,1 through 10,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,125.25,77.16,245.45,26,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,131.66,114.45,202.63,15,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,187.92,129.79,12331.27,1 through 10,percent of total billed charges,,,
Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,205.87,198.72,2421.47,13,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,243.7,215.75,2937.65,21,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2628.27,225.32,3169.69,36,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,377.6,178.74,3179.57,69,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,3692.4,3692.4,3692.4,1 through 10,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,2389.48,2389.48,2389.48,1 through 10,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,241.93,198.05,2792.73,19,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2742.28,2537.17,3052.31,12,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,308.89,196.75,2575.63,13,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,332.76,332.76,332.76,1 through 10,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,210.85,199.83,2754.84,18,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,426.1,198.69,2873.28,1 through 10,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,457.03,216.32,3156.19,1 through 10,percent of total billed charges,,,
Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,3068.06,1152.23,4893.52,20,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1522.81,601.57,4114.88,23,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2409.07,624.53,5496.62,47,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2430.55,466.37,5599.24,68,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,388.18,388.18,388.18,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,3212.7,3212.7,5875.14,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1823.85,580.6,8459.54,15,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2764.85,511.71,5832.66,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,3057.3,1153.71,4669.85,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,2104.26,1570.09,4199.99,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2483.77,2239.54,7420.44,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1559.43,1138.74,3273.98,12,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3149.08,615.73,14172.08,1 through 10,percent of total billed charges,,,
Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7647.25,5218.54,12566.58,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,5658.28,4452.6,22678.58,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5126.9,2336.39,11378.52,19,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4878.77,2607.46,9563.24,31,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,3888.9,3888.9,3888.9,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,5534.64,4933.09,7262.23,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4000.72,3653.96,5260.65,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4552.68,2989.42,5199.52,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,3053.39,3053.39,3053.39,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,3148.1,3148.1,3148.1,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4284.27,3417.23,8334.61,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,7998.67,7998.67,7998.67,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8346.34,8346.34,9069.15,1 through 10,percent of total billed charges,,,
Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3330.91,3100.59,8321.57,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,9506.82,6290.47,18217.02,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10046.61,7299.05,13749.78,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,8129.89,5445.01,13405.97,32,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,7661.07,4873.48,16043.94,37,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,6434.35,6434.35,6434.35,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,7095.58,5111.29,12818.81,11,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,9104.27,6416.86,11853.32,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7548.49,4191.44,14822.11,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7280.83,5240.33,14741.37,16,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8031.29,4419.9,18501.42,1 through 10,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6727.47,4295.94,9376.72,12,percent of total billed charges,,,
Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,20040.07,19303.03,20479.51,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17147.16,13079.12,20694.97,17,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,11908.78,8413.94,20593.44,23,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,9151.16,9151.16,18303.52,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,16568.53,16568.53,16568.53,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,18085.7,17741.96,19844.69,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,17036.82,17036.82,17036.82,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,15630.59,15423.88,16298.55,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,14044.44,13558.3,22745.72,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,16206.04,15016.17,21647.01,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11275.39,11275.39,14520.73,1 through 10,percent of total billed charges,,,
Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,30846.43,30846.43,30846.43,1 through 10,percent of total billed charges,,,
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 7 Urology and Related Services,5377,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,33982.07,33982.07,37568.54,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,22031.25,22031.25,22031.25,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,36890.17,33242.85,43289.17,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,38048.69,35338.63,39695.55,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,29623.07,29623.07,29623.07,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,34514.08,34514.08,34514.08,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,26400.7,16020.17,35864.94,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,37387.17,37387.17,37387.17,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,29995.71,29995.71,29995.71,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28192.17,28192.17,33046.27,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,31498.92,31498.92,31548.13,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,29948.75,29948.75,33852.51,1 through 10,percent of total billed charges,,,
Level 8 Urology and Related Services,5378,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2784.56,2784.56,3452.18,1 through 10,percent of total billed charges,,,
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,3750.23,3750.23,3750.23,1 through 10,percent of total billed charges,,,
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,3980.32,3980.32,3980.32,1 through 10,percent of total billed charges,,,
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9383.93,9383.93,9383.93,1 through 10,percent of total billed charges,,,
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1662.29,1222.9,3098.06,38,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1513.34,1204.99,2460.63,80,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1498.05,1200.15,2467.83,117,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1504.16,1098.16,2430.52,1 through 10,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1498.05,1247.11,2423.14,27,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1641.02,1366.15,2715.75,40,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,128.09,128.09,128.09,1 through 10,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,2241.91,2241.91,2241.91,1 through 10,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1342.14,1079.57,2170.32,832,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1757.06,1378.52,2383.34,15,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1636.97,1372.08,2274.32,1 through 10,percent of total billed charges,,,
Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2107.48,507.11,2985.76,13,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1305.05,270.39,2665.6,27,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1097.23,269.32,2578.8,38,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1835.91,282.22,2781.7,23,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1133.43,222.88,4061.9,11,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,985.93,589.04,2032.81,61,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1548.77,354.53,2832.76,1 through 10,percent of total billed charges,,,
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,744.3,744.3,910.22,1 through 10,percent of total billed charges,,,
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,4311.85,1710.32,7764.25,28,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6662.4,6662.4,6662.4,1 through 10,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4110.33,2114.28,9163.1,43,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4769.82,2631.93,7944.08,71,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,6211.53,6211.53,6211.53,1 through 10,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,5310.1,3514.25,9208.04,23,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,5558.97,2263.96,8021.44,37,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6408.6,5760.04,7644.76,1 through 10,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3851.89,1849.72,7603.15,93,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2490.46,2490.46,2490.46,1 through 10,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,5506.23,936.42,6408.47,1 through 10,percent of total billed charges,,,
Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,10753.11,10753.11,10753.11,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11365.73,7754.55,16751.37,17,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,8225.01,7153.46,11747.21,14,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,4069.55,4069.55,4069.55,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,8572.46,4525.5,13119.51,11,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,9547.98,7810.39,18016.76,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10061.71,10061.71,10061.71,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8193.65,6790.82,15812.41,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,11184.28,11184.28,11184.28,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,4267.17,4267.17,11311.17,1 through 10,percent of total billed charges,,,
Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,19680.78,19680.78,19680.78,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16199.9,16199.9,16199.9,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15309.2,15309.2,15309.2,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,17319.9,15786.22,21172.79,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,15476.55,15476.55,15476.55,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8277.47,8277.47,8277.47,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,14113.71,14113.71,14113.71,1 through 10,percent of total billed charges,,,
Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,5541.04,5541.04,5733.77,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,5419.99,5419.99,5419.99,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6113.71,5072.18,6811.49,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,6249.58,5340.37,11928.61,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,6720.16,6720.16,6720.16,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,7224.24,6059.43,8393.58,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,6506.96,5914.87,10678.68,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6275.74,4211.71,8089.87,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6092.8,4095.47,18851.83,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9719.44,9719.44,10954.68,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,8673.27,8673.27,8673.27,1 through 10,percent of total billed charges,,,
Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,22109.61,22109.61,26266.83,1 through 10,percent of total billed charges,,,
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19503.64,19503.64,19503.64,1 through 10,percent of total billed charges,,,
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,37106.56,37106.56,37106.56,1 through 10,percent of total billed charges,,,
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,25998.9,25998.9,25998.9,1 through 10,percent of total billed charges,,,
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22069.4,22069.4,22069.4,1 through 10,percent of total billed charges,,,
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,35538.9,35538.9,35538.9,1 through 10,percent of total billed charges,,,
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2832.88,149.85,2924.51,180,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,261.33,125.77,896.57,103,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2841.51,243.21,2927.02,595,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2827.68,142.41,2924.52,966,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,147.33,81.67,1618.69,15,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,272.18,175.62,2851.69,1 through 10,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,119.84,119.84,119.84,1 through 10,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2835.72,263.34,2923.9,305,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2537.06,134.47,2893.67,297,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,230.34,5.58,2381.82,97,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,2883.1,2883.1,2883.1,1 through 10,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,130.17,130.17,149.89,1 through 10,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,251.21,121.09,580.69,197,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,306.41,84.86,2327.61,30,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2863.23,357.8,2950.08,100,percent of total billed charges,,,
Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,472.7,254.39,3258.12,31,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1272.31,1032.44,3558.45,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,370.88,190.41,2262.87,50,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,420.48,143.97,2606.65,123,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,537.13,76.32,1443.31,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,888.63,888.63,888.63,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,495.79,192.6,5140.01,35,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,444.91,171.46,2448.46,37,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,225.48,3.12,1398.92,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,472.98,472.98,472.98,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1184.08,1184.08,1184.08,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,422.86,243.35,3607.72,45,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1165.79,683.19,6068.16,1 through 10,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,471.01,339.32,3891.01,23,percent of total billed charges,,,
Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,3048.36,3048.36,3048.36,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2974.8,2974.8,2974.8,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5805.65,5805.65,5805.65,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2690.86,1603.82,5723.41,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1929.99,1070.74,2924.52,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2625.35,2406.98,7344.91,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,936.75,936.75,936.75,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1436.9,1436.9,1436.9,1 through 10,percent of total billed charges,,,
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,8652.24,8652.24,8652.24,1 through 10,percent of total billed charges,,,
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9117.27,9117.27,9117.27,1 through 10,percent of total billed charges,,,
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3604.12,3604.12,3604.12,1 through 10,percent of total billed charges,,,
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2827.11,2827.11,2827.11,1 through 10,percent of total billed charges,,,
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7516.27,7516.27,7516.27,1 through 10,percent of total billed charges,,,
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7590.54,7590.54,7590.54,1 through 10,percent of total billed charges,,,
Level 1 Neurostimulator and Related Procedures,5461,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1496.38,1496.38,1496.38,1 through 10,percent of total billed charges,,,
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,16931.62,16931.62,19441.04,1 through 10,percent of total billed charges,,,
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,14681.42,13106.06,16291.39,1 through 10,percent of total billed charges,,,
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,21591.04,21591.04,21591.04,1 through 10,percent of total billed charges,,,
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5289.39,5289.39,5289.39,1 through 10,percent of total billed charges,,,
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Neurostimulator and Related Procedures,5462,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,23149.2,23149.2,23149.2,1 through 10,percent of total billed charges,,,
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,29214.03,23151.69,38220.13,1 through 10,percent of total billed charges,,,
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,23141.56,23141.56,23141.56,1 through 10,percent of total billed charges,,,
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,23468.6,23468.6,23468.6,1 through 10,percent of total billed charges,,,
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1225.63,1225.63,1225.63,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,981.58,981.58,1585.31,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,983.42,944.67,1387.51,12,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,976.08,976.08,1211.6,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,609.87,598.75,818.28,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,848.75,848.75,848.75,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,843.91,843.91,843.91,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,955.57,955.57,955.57,1 through 10,percent of total billed charges,,,
Laser Eye Procedures,5481,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1529.44,977.53,2321.43,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,336.12,324.45,709.31,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,829.44,332.69,1452.28,14,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,753.11,323.02,2478.39,41,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,713.76,356.88,1376.94,15,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,711.23,711.23,742.94,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,381.52,381.52,381.52,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,920.85,920.85,920.85,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,601.05,601.05,613.14,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1321.41,558.57,3139.7,1 through 10,percent of total billed charges,,,
"Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,355.32,286.47,595.83,127,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,381.24,242.92,833.59,180,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,378.86,129.58,681.7,460,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,381.23,243.31,830.81,658,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,338.77,336.13,1308.76,1 through 10,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,274.46,226.05,644.79,14,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,351.87,226.05,537.82,24,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,193.07,186.85,632.88,1 through 10,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,379.55,247.84,697.68,271,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,379.44,238.98,1209.84,392,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,328.08,168.61,638.64,151,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,375.5,375.5,375.5,1 through 10,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,388.08,229.94,526.89,14,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,341.55,329.69,567.01,356,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,470.21,309.73,1130.23,1 through 10,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,357.98,218.16,637.49,55,percent of total billed charges,,,
Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,385.12,254.22,1382.75,105,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,716.82,293.89,2124.63,175,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,539.28,203.03,2130,150,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,696.2,240.66,1822,359,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,707.88,241.02,2203.61,724,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,684.71,380.42,2988.92,1 through 10,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,257.6,119.38,682.27,15,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,429.78,226.64,2326.48,19,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,751.66,203.74,2093.64,11,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,734.01,335.57,2432.78,239,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,556.23,216.95,1732.03,270,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,363.51,123.83,1616.15,204,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,1569.85,1569.85,1569.85,1 through 10,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,576.13,170.85,2326.28,28,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,731.37,412.06,1606.51,357,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1177.6,388.87,2676.86,12,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,539.28,208.84,2199.97,99,percent of total billed charges,,,
Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,750.73,324.23,2477,117,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1929.44,475.78,3650.27,57,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1784.56,475,2554.72,61,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1843.8,216.09,3228.54,111,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2029.62,496.08,4119.14,201,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,922.42,922.42,922.42,1 through 10,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,913.74,913.74,1042.11,1 through 10,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1741.61,674.79,3496.17,12,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1684.01,1684.01,2403.9,1 through 10,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2015.5,475.78,3142.18,50,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1063.09,469.41,2564.91,47,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1921.6,736.77,3288.03,61,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,3257.03,191.83,3332.89,14,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,901.87,864.65,3310.27,132,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,840.17,840.17,840.17,1 through 10,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1550.47,237.97,3571.51,46,percent of total billed charges,,,
Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1992.42,334.94,4161.19,49,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,873.06,432.52,1902.81,78,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,872.29,798.37,1338.57,64,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,945.05,766.97,1440.96,239,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,945.05,830.25,1605.32,389,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,2962.37,2962.37,2962.37,1 through 10,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,693.52,459.8,5292.88,1 through 10,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,916.27,863.85,2134.74,12,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,718.53,718.53,1652.12,1 through 10,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,935.69,756.04,1606.28,109,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,932.38,776.48,1398.57,86,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,697.83,427.63,894.76,92,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,890.59,606.51,1149.49,1 through 10,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,838.31,423.35,3097.19,121,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,904.67,770.53,1368.25,21,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,873.79,756.19,2224.45,53,percent of total billed charges,,,
Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,697.97,317.6,907.56,86,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,614.74,391.43,827.43,61,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,744.28,386.81,1238.07,172,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,732.45,353.83,1188.25,347,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,672.53,363.01,795.65,17,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,419.09,311.3,1510.51,27,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,633.05,633.05,922.14,1 through 10,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,731.36,379.48,1259.75,90,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,835.06,311.72,1420.25,48,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,542.51,212.94,924.71,98,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,721.77,721.77,721.77,1 through 10,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,779.07,602.44,832.72,16,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,547.88,372.34,1093.22,73,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,659.86,272.65,1190.43,59,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,704.15,371.92,870.83,50,percent of total billed charges,,,
Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1879.7,884.88,3147.46,42,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1659.85,390.36,3475.62,28,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1549.3,300.04,2945.31,58,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1804.29,403.05,2905.78,151,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1469.04,1469.04,1469.04,1 through 10,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,756.77,353.81,1742.05,1 through 10,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1261.22,519.41,2338.03,1 through 10,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1804.08,407.18,2819.56,40,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1503.41,413,2809.56,51,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1358.98,174.61,2298.21,27,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,3727.84,3727.84,3727.84,1 through 10,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,524.44,328.86,845.86,1 through 10,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,873.19,143.33,2420.09,30,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,407.58,407.58,911.05,1 through 10,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1958.62,480.02,2597.39,22,percent of total billed charges,,,
Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1804.7,573.89,3155.45,38,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1235.63,1235.63,1235.63,1 through 10,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,888.4,879.43,1419.15,1 through 10,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,970.62,761.27,1433.34,13,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1266.75,952.27,1502.36,16,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1309.31,1309.31,1433.34,1 through 10,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1277.27,789.46,1414.11,12,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,374.61,348.91,1087.05,1 through 10,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,860.81,860.81,860.81,1 through 10,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2199.12,2199.12,2199.12,1 through 10,percent of total billed charges,,,
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,997.21,997.21,997.21,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1539,1271.57,4400.5,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1247.53,1034.57,3557.08,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1483.71,1162.23,3040.16,18,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1035.96,1035.96,1058.8,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1363.12,1363.12,1414.58,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2609.98,2609.98,2609.98,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2007.05,2007.05,2007.05,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1248.75,1248.75,1248.75,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1584.61,1584.61,1584.61,1 through 10,percent of total billed charges,,,
Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1916.73,1916.73,1916.73,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2273.32,1649.51,2273.32,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1970.47,1633.96,2290.45,11,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1691.62,1400.19,2320.55,14,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2035.11,2035.11,2314.92,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2015.19,2015.19,2015.19,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1422.02,1345.62,2000.36,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2079.02,2079.02,2079.02,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2296.5,2296.5,2296.5,1 through 10,percent of total billed charges,,,
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2249.38,1482.33,5520.02,19,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2370.78,1573.88,2431.38,11,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2296.18,1710.03,3940.31,12,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2372.57,1984.07,2413.38,29,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,2221.57,2221.57,2221.57,1 through 10,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1973.44,1973.44,1973.44,1 through 10,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2291.18,1903.89,5523.33,12,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,2361.23,2143.98,2667.86,15,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1780.45,1426.94,2195.99,24,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,832.8,832.8,832.8,1 through 10,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2139.72,1678.68,2161.24,1 through 10,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2111.42,2091.42,2115.13,1 through 10,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2419.78,2394.39,5711.13,1 through 10,percent of total billed charges,,,
Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,7173.95,155.59,14218.68,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6707.77,6332.18,9823.95,16,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6903.18,5613.92,7669.72,19,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,7121.99,5707.27,10430.62,71,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,6479.91,6479.91,10032.93,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,6595.7,6532.18,6829.81,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,6328.62,6328.62,6328.62,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,7158.5,6829.69,10711.22,13,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,6202.18,6190.58,7119.1,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6142.36,5930.91,12265.08,25,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,6401.53,6105.48,6401.53,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6530.7,6380.73,8900.8,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6358.03,5855.98,6732.92,1 through 10,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7325.57,6966.39,10739.45,18,percent of total billed charges,,,
Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,22989.59,22989.59,22989.59,1 through 10,percent of total billed charges,,,
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,16836.89,16836.89,16836.89,1 through 10,percent of total billed charges,,,
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13010.69,13010.69,13010.69,1 through 10,percent of total billed charges,,,
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,8330.44,8330.44,8330.44,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6155.23,6155.23,6155.23,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4124.53,1112.28,6771.65,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,192.81,177.39,12594.99,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2288.7,1152.32,8928.56,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6528.89,6528.89,6528.89,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2206.08,2206.08,2206.08,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,141.61,141.61,17059.36,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,200.73,180.66,200.73,1 through 10,percent of total billed charges,,,
Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4248.83,2430.94,5089.66,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,5510.72,5510.72,5510.72,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3255.14,1145.28,6238.03,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4355.88,3401.21,5387.59,21,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,5958.22,5958.22,5958.22,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,5909.58,5909.58,5909.58,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3635.4,3007.4,4073.17,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4209.06,4209.06,4209.06,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,3057.93,1227.7,4404.44,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4567.43,3910.41,5677.84,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3936.09,3151.99,5025.49,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,4184.47,3404.8,5450.6,1 through 10,percent of total billed charges,,,
Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,5626.95,2924.38,9340.65,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,8031.78,2451.77,10797.47,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,7604.96,1822.46,10573.93,19,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,9816.89,9816.89,9816.89,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2976.12,1488.06,7270.07,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1329.35,530.69,3904.72,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,9965.36,9965.36,9965.36,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6995.92,6995.92,8129.71,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8111.22,8111.22,8111.22,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6209.67,6209.67,15582.16,1 through 10,percent of total billed charges,,,
Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10011.08,2430.76,15800.41,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,9234.44,3226.4,31307.1,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11127,1290.54,20951.59,38,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,7562.24,302.01,19883.05,48,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,8446.43,8446.43,16795.4,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,15970.02,15970.02,15970.02,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3436.56,271.81,16034.46,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,21709.45,8132.32,27059.48,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6970.49,252.74,19087.66,19,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,9864.45,9864.45,9864.45,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9492.49,3223.21,16286.32,16,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3852.86,698.81,12339.21,17,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13730.58,10201.33,16521.9,1 through 10,percent of total billed charges,,,
Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,19167.12,14620.65,27975.73,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,14765.93,14074.5,18646.35,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18987.4,13982.33,19347.57,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,15157.8,11567.6,20158.94,21,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,15635.66,15635.66,15635.66,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,14818.07,13644.96,18972.56,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,19444.2,19444.2,19709.19,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6576.89,4125.36,12676.83,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,13097.53,13097.53,13097.53,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16858.09,16858.09,19735.34,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,11465.26,7735.77,13733.79,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,14735.48,7657.29,20039.22,1 through 10,percent of total billed charges,,,
Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1603.74,1603.74,1603.74,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,2850,1084.96,9694.54,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2241.18,334.63,9695.96,11,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2516.04,450.31,18668.6,23,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,13956.38,2304.4,16952.61,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,13855.28,9515.54,24046.19,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2613.75,2613.75,2613.75,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3550.4,623.87,4692.44,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6310.66,6310.66,15188.2,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3199.35,2327,17790.79,1 through 10,percent of total billed charges,,,
Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1070.44,1070.44,1070.44,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1167.66,580.82,17174.93,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4423.55,592.85,15746.8,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,6958.03,6958.03,6958.03,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1568.14,1568.14,1568.14,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3473.84,3033.99,19092.04,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,8497.87,8497.87,47522.6,1 through 10,percent of total billed charges,,,
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,544.36,299.44,1935.67,12,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2638.56,2222.21,3137.1,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,2279.2,898.64,4154.51,17,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2126.42,662.86,5937.79,27,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,2116.89,2116.89,2116.89,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3537.37,811.19,4938.75,12,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,963.95,963.95,1557.15,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,132125.63,132125.63,132125.63,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1249.58,1249.58,1249.58,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1898.09,656.65,16252.72,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1479.97,1479.97,1479.97,1 through 10,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2635.57,243.54,28155.97,16,percent of total billed charges,,,
Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,21012.15,21012.15,21012.15,1 through 10,percent of total billed charges,,,
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,39.2,19.6,186.45,182,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,154.72,106.49,616.33,1 through 10,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,39.6,19.78,188.1,467,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,39.32,19.62,188.11,386,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1580.78,1580.78,1580.78,1 through 10,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,39.2,35.28,186.01,416,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,39.08,35.19,185.73,350,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,95.6,95.6,95.6,1 through 10,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,35.12,17.56,166.82,178,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,148.28,18.46,148.28,11,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,152.78,39.54,188.1,51,percent of total billed charges,,,
Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,3908.36,209.54,8219.59,42,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,751.41,119.55,3413.92,33,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4747.57,131.27,5701.33,166,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,4339.28,69.93,7202.71,281,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,3083.27,124.01,3344.81,1 through 10,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,5536.42,249.03,5644.66,11,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,109.63,109.63,375.21,1 through 10,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,3624.8,347.67,5701.96,97,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4882.08,133.82,5777.14,109,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,3022.15,59.49,4789.05,74,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,5034.46,5034.46,5034.46,1 through 10,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1466.91,924.93,3187.05,1 through 10,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,593.92,118.16,4990.04,56,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3079.95,357.07,4877.4,23,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,4984.61,322.25,6623.33,23,percent of total billed charges,,,
Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1204.78,639.53,2372.21,62,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1133.54,701.44,10550.54,57,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1872.78,718.56,7146.39,168,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1291.6,691.4,7101.9,303,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1195.69,708.93,1957.34,1 through 10,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1012.14,1012.14,1012.14,1 through 10,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1811.86,759.78,11673.47,98,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1924.39,648.1,11134.2,98,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,852.1,524.58,1710.72,93,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,9492.18,9492.18,9492.18,1 through 10,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1109.87,1109.87,1111.79,1 through 10,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1579.82,603.17,4187.28,123,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3003.07,676.05,4209.44,81,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1955.07,803.03,31502.91,48,percent of total billed charges,,,
Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,16146.75,823.1,38435.85,152,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4440.56,671.32,24054.78,135,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11426.18,965.77,26220.82,363,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,9931.24,1208.27,31396.19,606,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,2604.52,1093.68,10558.17,21,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,23245.23,21391.63,23955.92,23,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,8892.6,845.93,31085.49,104,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,4247.69,733.95,24851.99,111,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4583.94,808.51,23957.36,209,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,25423.24,25423.24,25423.24,1 through 10,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,18566.01,2139.99,23336.81,12,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3656.58,682.9,23513.48,155,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,20602.32,1084.09,26692.46,131,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,18436.13,2595.22,25694.35,163,percent of total billed charges,,,
Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,501.09,367.05,1448.18,122,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,924.92,319.83,1450.63,76,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,411.05,194.38,1425.2,332,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,491.58,336.74,1522.4,539,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1989.19,1989.19,1989.19,1 through 10,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1312.06,181.93,2267.1,1 through 10,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,521.95,447.16,1292.12,1 through 10,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,575.33,575.33,575.33,1 through 10,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,466.11,339.58,1410.79,184,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,405.86,335.02,1516.89,168,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,996.65,315.23,1483.02,89,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,1425.84,1425.84,1425.84,1 through 10,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,740.84,393.36,1336.56,19,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,364.55,316.75,1251.45,313,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,323.96,323.96,323.96,1 through 10,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,812.49,362.47,1356.17,42,percent of total billed charges,,,
Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,510.8,357.16,1590.1,107,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1522.42,473.5,1852.05,205,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1285.98,571.26,1699.82,90,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1411.79,433.01,1755.78,400,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1447.83,515.55,1802.93,770,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1288.75,537.73,1545.45,21,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1289.28,653.49,1492.75,13,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1080.06,540.73,1396.83,1 through 10,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1425.48,539.69,1774.78,245,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1311.47,493.65,1712.96,166,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1041.74,518.14,1594.39,146,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,1425.59,1425.59,1553.13,1 through 10,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1308.82,668.08,1441.68,1 through 10,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,788.71,327.93,1616.94,337,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3471.66,3471.66,3471.66,1 through 10,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1289.48,683,1697.1,57,percent of total billed charges,,,
Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1448.01,493.39,1726.96,132,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1159.53,1119.24,1200.4,1 through 10,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,743.41,448.45,1558.35,27,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1242.54,590.32,1680.57,67,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1188.35,530.59,1609.92,87,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1385.4,842.61,1570.74,1 through 10,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1145.55,1145.55,1145.55,1 through 10,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,888.58,483.2,1419.42,35,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1204.26,554.16,1671.15,24,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,847.56,479.57,1173.29,1 through 10,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,325.51,325.51,325.51,1 through 10,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,525.64,490.51,1103,23,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,627.97,627.97,1316.36,1 through 10,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,704.21,513.13,1933.3,19,percent of total billed charges,,,
Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1744.87,64.94,1927.32,61,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1788.47,1717.33,1890.68,19,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1834.83,65.2,1946.98,208,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1835.78,65,1937.89,278,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1066.74,1066.74,1066.74,1 through 10,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1869.5,1869.5,1869.5,1 through 10,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,1752.7,1752.7,1752.7,1 through 10,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1831.1,64.8,1927.32,92,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1774.16,63.98,1969.32,94,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1637.54,1327.1,1846.16,30,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,1682.99,1339.56,1693.49,1 through 10,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1674.92,58.05,1798.5,117,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1691.59,1677.12,1758.61,1 through 10,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1868.29,66.11,1947.25,36,percent of total billed charges,,,
Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1.78,1.78,1.78,1 through 10,percent of total billed charges,,,
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,135.53,135.53,135.53,1 through 10,percent of total billed charges,,,
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,173.29,173.29,173.29,1 through 10,percent of total billed charges,,,
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8413.24,8413.24,8413.24,1 through 10,percent of total billed charges,,,
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,152.7,152.7,152.7,1 through 10,percent of total billed charges,,,
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,10549.73,10549.73,10549.73,1 through 10,percent of total billed charges,,,
Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,312.47,312.47,312.47,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,523.61,523.61,981.13,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,324.62,35.41,338.83,18,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,326.45,294.26,648.87,23,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,154.79,154.79,154.79,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,335.41,323.66,1006.22,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,322.52,156.94,587.5,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,264.24,115.15,300.9,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,293.16,31.16,579.98,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,429.84,429.84,429.84,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,329.9,144.17,2162.09,1 through 10,percent of total billed charges,,,
Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,353.42,82.35,442.21,56,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,194.39,86.53,547.84,86,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,140.01,86.53,457.76,129,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,167.4,79.46,462.06,304,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,13270.11,13270.11,13270.11,1 through 10,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,86.89,51.62,301.45,1 through 10,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,250.94,80.67,442.26,12,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,114.99,114.99,377.13,1 through 10,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,173,86.12,458.11,100,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,184.79,83.66,514.79,89,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,294.31,77.57,918.63,90,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,298.03,298.03,298.03,1 through 10,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,139.64,80.3,15370.06,1 through 10,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,100.88,77.16,271.08,169,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,344.82,70.3,412.36,31,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,294.08,86.53,474.36,38,percent of total billed charges,,,
Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,564.01,109.83,1042.85,63,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,566.65,139.91,1166.26,119,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,571.93,112.05,1178.15,193,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,562.32,101.46,1178.23,368,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,4613.04,1851.23,7460,1 through 10,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,197.16,86.18,267.87,1 through 10,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,758.29,83.19,1055.89,17,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,74.12,74.12,74.12,1 through 10,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,780.71,114.75,1991.49,99,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,609.5,128.72,1097.66,109,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,390.87,87.77,871.07,131,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,87.88,87.88,87.88,1 through 10,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,525.32,84.99,1015.73,13,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,507.23,115.11,1811.11,171,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1958.65,790.13,3570.76,1 through 10,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,555.44,368.49,941.22,68,percent of total billed charges,,,
Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,629.89,198.57,2159.56,68,percent of total billed charges,,,
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1838.73,502.85,4304.76,21,percent of total billed charges,,,
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,2426.66,391.96,8206.8,1 through 10,percent of total billed charges,,,
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1231.07,579.92,3029.81,1 through 10,percent of total billed charges,,,
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,3236.51,1373.08,4911.7,13,percent of total billed charges,,,
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,503.32,362.21,2289.28,1 through 10,percent of total billed charges,,,
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 5 Minor Procedures,5735,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1695.18,1562.08,1956.66,1 through 10,percent of total billed charges,,,
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Electronic Analysis of Devices,5743,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,126.64,126.64,126.89,63,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,137.2,137.2,137.5,119,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,137.2,110.88,138.6,265,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,137.2,116.98,137.55,392,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,125.72,125.72,125.72,1 through 10,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,137.2,107.2,137.2,173,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,136.85,123.16,136.85,203,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,118.07,118.07,118.07,44,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,122.92,122.92,122.92,54,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,120.24,96.38,128.96,49,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,138.6,137.21,138.6,69,percent of total billed charges,,,
Cardiac Rehabilitation,5771,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,851.63,851.63,870.53,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1040.08,995.29,2839.71,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,855.41,620.76,2295.26,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,889.26,889.26,889.26,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,789.39,789.39,789.39,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,829.82,829.82,829.82,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1635.64,1635.64,1635.64,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2072.99,2072.99,2072.99,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1484.42,1484.42,1484.42,1 through 10,percent of total billed charges,,,
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1477.48,1477.48,1477.48,1 through 10,percent of total billed charges,,,
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,580.73,580.73,1471.28,1 through 10,percent of total billed charges,,,
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1000.9,1000.9,1964.01,1 through 10,percent of total billed charges,,,
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,485.26,485.26,485.26,1 through 10,percent of total billed charges,,,
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,683.75,683.75,756.76,1 through 10,percent of total billed charges,,,
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,115.79,110.97,124.42,35,percent of total billed charges,,,
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,114.62,107.95,130.24,48,percent of total billed charges,,,
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,451.63,233.92,490.39,1 through 10,percent of total billed charges,,,
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,114.23,110.36,118.26,35,percent of total billed charges,,,
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,191.78,191.78,508.89,14,percent of total billed charges,,,
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 2 Health and Behavior Services,5822,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,515.37,332.36,590.71,151,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,475.83,262.89,492.98,51,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,359.66,286.77,547.85,3314,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,358.26,251.98,564.87,4300,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,490.72,485.87,534.03,1 through 10,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,318.62,317.52,328.52,1 through 10,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,317.42,317.42,476.14,1 through 10,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,513.47,292.12,578.59,1127,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,504.05,321.11,566.03,2504,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,404.76,256.76,473.33,796,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,508.11,338.73,521.03,14,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,380.54,380.54,380.54,1 through 10,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,485.38,323.57,534.03,26,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,502.98,323.57,701.1,1 through 10,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,362.42,358.14,468.98,16,percent of total billed charges,,,
Level 3 Health and Behavior Services,5823,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,193.88,49,677.47,1 through 10,percent of total billed charges,,,
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1578.54,1578.54,2208.28,1 through 10,percent of total billed charges,,,
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7516.16,7516.16,7516.16,1 through 10,percent of total billed charges,,,
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Plasma, frz between 8-24hour",9513,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,130.89,120.75,196.37,3040,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,121.98,112.8,184.91,2163,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,130.9,81.89,196.37,7907,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,130.28,100.18,196.33,11920,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,121.71,65.11,2754.82,1 through 10,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,120.09,72.49,181.11,195,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,123.28,117.8,187.16,294,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,107.75,96.88,196.37,31,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,129.58,123.37,196.04,3791,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,129.25,116.23,195.83,3260,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,119.5,111.51,179.24,2895,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,127.63,127.63,240.73,39,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,120.21,89.71,185.75,244,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,117.27,115.99,175.9,4965,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,118.73,114.61,178.12,29,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,116.6,111.42,176.72,1111,percent of total billed charges,,,
Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,130.9,125.6,197.94,2135,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,204.53,71.84,538.65,872,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,170.04,52.25,349.6,694,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,176.95,52.9,476.18,1732,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,194.89,49.8,557.9,3157,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1324.39,1324.39,66758.23,1 through 10,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,154.92,61.09,345.12,54,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,221.08,98.72,494.84,67,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,94.66,34.66,1313.16,1 through 10,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,196.98,61.43,528.78,1102,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,155.7,41.01,408.7,2128,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,171.19,47.73,320,1104,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,263.37,242.82,509.7,1 through 10,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,184.93,66.96,370.08,71,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,191.29,39.73,430.17,418,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,14726.51,14726.51,14726.51,1 through 10,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,173.37,56.22,373.25,328,percent of total billed charges,,,
Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,203.3,63.75,557.58,520,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,732.61,215.42,2228.17,108,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,376.05,147,1476.6,215,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,324.61,147,1301.8,642,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,294,109.44,1105.92,927,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,327.94,169.88,586.32,1 through 10,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,564.43,403.21,1197.59,1 through 10,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1097.66,226.1,1624.24,12,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,417.37,286.42,720.5,1 through 10,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,352.56,147,983.65,338,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,329.9,113.98,1266,656,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,463.03,178.9,1267.46,132,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,449.63,375,518.16,1 through 10,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,273.51,260.44,741.45,12,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,339.76,131.7,1145.54,605,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,566.72,159.41,1931.6,1 through 10,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,401.96,211.62,1007.11,36,percent of total billed charges,,,
Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,364.12,148.5,1059.27,139,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1361.67,1345.5,1382.65,18,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,1445.77,1417.04,1468.05,44,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,1446.05,1428.6,1483.02,115,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,1431.45,1417.03,1468.04,166,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1355,1355,1355,1 through 10,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,1361.67,1361.67,1361.67,1 through 10,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,1431.45,1384.16,1468.04,60,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,1442.08,1413.41,1464.3,190,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,1321.23,1229.45,1334.43,39,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,1445.95,1445.95,1445.95,1 through 10,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,599.2,599.2,599.2,1 through 10,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1309.06,1309.06,1309.06,1 through 10,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1272.61,1257.05,1307.75,1 through 10,percent of total billed charges,,,
Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1483.02,1431.49,1483.02,27,percent of total billed charges,,,
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,149.02,149.02,149.02,1 through 10,percent of total billed charges,,,
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,23.41,23.41,23.41,1 through 10,percent of total billed charges,,,
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,243.41,223.85,279.92,33,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,301.3,301.3,301.3,1 through 10,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,306.19,284.32,313.84,1 through 10,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,302.86,302.86,313.84,1 through 10,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,276.24,267.06,276.4,20,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,256.2,256.2,256.2,1 through 10,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,263.51,251.84,289.68,104,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,246.12,25,246.12,29,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,215.11,212.98,270.2,74,percent of total billed charges,,,
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Medicine,N809,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,20342.66,20342.66,20342.66,1 through 10,percent of total billed charges,,,
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,5046.18,5046.18,5046.18,1 through 10,percent of total billed charges,,,
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1600.91,1600.91,1600.91,1 through 10,percent of total billed charges,,,
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,121.94,121.94,121.94,1 through 10,percent of total billed charges,,,
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,234.24,234.24,234.24,1 through 10,percent of total billed charges,,,
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,2792.43,2792.43,2792.43,1 through 10,percent of total billed charges,,,
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,87.8,87.8,87.8,1 through 10,percent of total billed charges,,,
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,427.16,426.78,442.26,38,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,453.54,437.78,907.07,39,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,458.11,433.2,906.26,117,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,453.99,356.87,916.22,147,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,422.83,422.83,422.83,1 through 10,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,376.75,376.75,376.75,1 through 10,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,453.53,437.78,908.61,56,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,451.98,407.14,904.75,58,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,418.24,209.12,836.48,28,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,406.33,405.97,820.86,91,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,404.02,401.17,412.36,18,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,458.16,212.6,916.32,23,percent of total billed charges,,,
Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,248.13,248.13,248.13,1 through 10,percent of total billed charges,,,
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,266.17,266.17,266.17,1 through 10,percent of total billed charges,,,
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
HC MED/SURG/GYN PRIVATE,1110001,CDM,111,RC,,,facility,both,,,,1200,1200,,,,,,,,,,,,,Gross Charge Type: BMC 01 MED/SURG/IMC/SSU
HC MED/SURG GYN-SEMI-PRIV,1210001,CDM,121,RC,,,facility,both,,,,2006.25,2006.25,,,,,,,,,,,,,Gross Charge Type: BMC 01 MED/SURG/IMC/SSU
HC MED/SURG/GYN INTERMED SEMI-PRIV,1210002,CDM,121,RC,,,facility,both,,,,2133.7,2133.7,,,,,,,,,,,,,Gross Charge Type: BMC 01 MED/SURG/IMC/SSU
HC LOWER LEVEL OF CARE,1219901,CDM,121,RC,,,facility,both,,,,350,350,,,,,,,,,,,,,Gross Charge Type: BMC 01 MED/SURG/IMC/SSU
HC OB SEMI-PRIVATE ROOM,1220001,CDM,122,RC,,,facility,both,,,,2474.59,2474.59,,,,,,,,,,,,,Gross Charge Type: BMC 04 OB
GENERAL PEDS ROOM DAILY,1230001,CDM,123,RC,,,facility,both,,,,2744.37,2744.37,,,,,,,,,,,,,Gross Charge Type: BMC 02 PEDIATRICS ACUTE
PSYCH ROOM DAILY,1240001,CDM,124,RC,,,facility,both,,,,2435.41,2435.41,,,,,,,,,,,,,Gross Charge Type: BMC 03 PSYCHIATRY
HC PSYCH LOWER OF CARE,1249901,CDM,124,RC,,,facility,both,,,,500,500,,,,,,,,,,,,,Gross Charge Type: BMC 03 PSYCHIATRY
HC PSYCH LOWER OF CARE,1249901,CDM,124,RC,,,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: BMC 09 NICU
HC  SEMI-PRIV DETOX,1260001,CDM,126,RC,,,facility,both,,,,565,565,,,,,,,,,,,,,Gross Charge Type: BMC 03 PSYCHIATRY
HC  SEMI-PRIV DETOX,1260001,CDM,126,RC,,,facility,both,,,,832.91,832.91,,,,,,,,,,,,,Gross Charge Type: BMC 01 MED/SURG/IMC/SSU
HC REHAB SEMI-PRIV,1280001,CDM,128,RC,,,facility,both,,,,1882.02,1882.02,,,,,,,,,,,,,Gross Charge Type: BMC 16 REHAB (RHB)
HC LOWER LEVEL CARE REHAB (R/C 16),1289901,CDM,128,RC,,,facility,both,,,,402.71,402.71,,,,,,,,,,,,,Gross Charge Type: BMC 16 REHAB (RHB)
HC NICU LOWER LEVEL OF CARE,1709901,CDM,170,RC,,,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: BMC 09 NICU
HC NEWBORN 1 ROOM DAILY,1710001,CDM,171,RC,,,facility,both,,,,647.84,647.84,,,,,,,,,,,,,Gross Charge Type: BMC 14 NURSERY
HC NEWBORN 2 ROOM DAILY,1720001,CDM,172,RC,,,facility,both,,,,2649.7,2649.7,,,,,,,,,,,,,Gross Charge Type: BMC 09 NICU
HC NEWBORN 3 ROOM DAILY,1730001,CDM,173,RC,,,facility,both,,,,3156.48,3156.48,,,,,,,,,,,,,Gross Charge Type: BMC 09 NICU
HC NEWBORN 4 ROOM DAILY,1740001,CDM,174,RC,,,facility,both,,,,3553.17,3553.17,,,,,,,,,,,,,Gross Charge Type: BMC 09 NICU
ICU ROOM,2000001,CDM,200,RC,,,facility,both,,,,4399.59,4399.59,,,,,,,,,,,,,Gross Charge Type: BMC 06 ICU
ICU SURG ROOM DAILY,2010001,CDM,201,RC,,,facility,both,,,,4399.59,4399.59,,,,,,,,,,,,,Gross Charge Type: BMC 06 ICU
HC ICU/BURN CARE ROOM DLY,2070001,CDM,207,RC,,,facility,both,,,,9770.24,9770.24,,,,,,,,,,,,,Gross Charge Type: BMC 10 BURN
HC BURN INTERMED ROOM DLY,2070002,CDM,207,RC,,,facility,both,,,,7128.47,7128.47,,,,,,,,,,,,,Gross Charge Type: BMC 10 BURN
ICU CARD ROOM DAILY,2100001,CDM,210,RC,,,facility,both,,,,4399.59,4399.59,,,,,,,,,,,,,Gross Charge Type: BMC 07 CCU
HC ADMISSION CHARGE,22100001,CDM,221,RC,,,facility,both,,,,398.21,398.21,,,,,,,,,,,,,Gross Charge Type: BMC 64 ADMISSIONS
HC HYDRATION IV INFUSION 1ST HOUR,26000001,CDM,260,RC,96360,HCPCS,facility,both,,,,528.43,528.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HYDRATION IV INFUSION EACH ADDL HOUR,26000002,CDM,260,RC,96361,HCPCS,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC IV INFUSION DRUG THERAPY 1ST HOUR,26000003,CDM,260,RC,96365,HCPCS,facility,both,,,,1188.97,1188.97,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC INFUSION DRUG THERAPY EA ADDL HOUR,26000004,CDM,260,RC,96366,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR",26000005,CDM,260,RC,96367,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IV INFUSION, CONCURRENT",26000006,CDM,260,RC,96368,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC THER/PROPH/DIAG INJ, SC/IM",26000007,CDM,260,RC,96372,HCPCS,facility,both,,,,70.47,70.47,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
"HC THER/PROPH/DIAG INJ, SC/IM",26000007,CDM,260,RC,96372,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC THER/PROPH/DIAG INJ, IV PUSH",26000008,CDM,260,RC,96374,HCPCS,facility,both,,,,660.54,660.54,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW",26000009,CDM,260,RC,96375,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME",26000010,CDM,260,RC,96376,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC SPINE/BRAIN PUMP REFILL PHYS,26000011,CDM,260,RC,95991,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC IRRIGATION OF IMPLANTED VAD,26000012,CDM,260,RC,96523,HCPCS,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,26000052,CDM,260,RC,96377,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 04/16/2021 HC IV INFUSION, BAMLANIVIMAB XXXX, INCLUDES INFUSION AND POST ADMINISTRATION",26000053,CDM,771,RC,,,facility,both,,,,309.6,309.6,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2025 HC IV INFUSION, CASIRIVIMAB & IMDEVIMAB, INCL INFUSION & POST ADM MONITOR",26000054,CDM,771,RC,,,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2025 HC IV INFUSION, BAMLANIVIMAB AND ETESEVIMAB, INCLUDES INFUSION AND POST ADMIN MONITORING",26000055,CDM,771,RC,,,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2025 HC IV INFUS/SUBSQ INJ, CASIRIVIMAB & IMDEVIMAB W/POST ADM MONITOR, REPEAT DOSES",26000056,CDM,771,RC,,,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,3,3,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: LAB-LABCORP AND QUEST CLIENT FEE SCHEDULE
HC METABOLIC PANEL TOTAL CA,30000004,CDM,301,RC,80048,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC METABOLIC PANEL TOTAL CA,30000004,CDM,301,RC,80048,HCPCS,facility,both,,,,8.46,8.46,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC METABOLIC PANEL TOTAL CA,30000004,CDM,301,RC,80048,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC METABOLIC PANEL TOTAL CA,30000004,CDM,301,RC,80048,HCPCS,facility,both,,,,23.03,23.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,10.56,10.56,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RENAL FUNCTION PANEL,30000006,CDM,301,RC,80069,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RENAL FUNCTION PANEL,30000006,CDM,301,RC,80069,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC RENAL FUNCTION PANEL,30000006,CDM,301,RC,80069,HCPCS,facility,both,,,,8.68,8.68,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC RENAL FUNCTION PANEL,30000006,CDM,301,RC,80069,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATIC FUNCTION PANEL,30000007,CDM,301,RC,80076,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEPATIC FUNCTION PANEL,30000007,CDM,301,RC,80076,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATIC FUNCTION PANEL,30000007,CDM,301,RC,80076,HCPCS,facility,both,,,,23.03,23.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GH SUPPRESSION PANEL,30000008,CDM,301,RC,80430,HCPCS,facility,both,,,,268.5,268.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GH SUPPRESSION PANEL,30000008,CDM,301,RC,80430,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARNITINE QUAN EA,30000009,CDM,301,RC,82379,HCPCS,facility,both,,,,650,650,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARNITINE QUAN EA,30000009,CDM,301,RC,82379,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHLORIDE; OTHER,30000010,CDM,301,RC,82438,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHLORIDE; OTHER,30000010,CDM,301,RC,82438,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VERY LONG FATTY ACID CHAINS,30000011,CDM,301,RC,82726,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF IGE,30000012,CDM,301,RC,82785,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF IGE,30000012,CDM,301,RC,82785,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INSULIN; TOTAL,30000013,CDM,301,RC,83525,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC INSULIN; TOTAL,30000013,CDM,301,RC,83525,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INSULIN; TOTAL,30000013,CDM,301,RC,83525,HCPCS,facility,both,,,,11.43,11.43,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC INSULIN; TOTAL,30000013,CDM,301,RC,83525,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TESTOSTERONE; TOTAL,30000014,CDM,301,RC,84403,HCPCS,facility,both,,,,25.81,25.81,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC TESTOSTERONE; TOTAL,30000014,CDM,301,RC,84403,HCPCS,facility,both,,,,36.5,36.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TESTOSTERONE; TOTAL,30000014,CDM,301,RC,84403,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TESTOSTERONE; TOTAL,30000014,CDM,301,RC,84403,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC T3; REVERSE,30000015,CDM,301,RC,84482,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T3; REVERSE,30000015,CDM,301,RC,84482,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL HGB SCREENING TEST,30000016,CDM,305,RC,85461,HCPCS,facility,both,,,,66.5,66.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FETAL HGB SCREENING TEST,30000016,CDM,305,RC,85461,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SICKLING OF RBC REDUCTION,30000017,CDM,305,RC,85660,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SICKLING OF RBC REDUCTION,30000017,CDM,305,RC,85660,HCPCS,facility,both,,,,38.5,38.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALLERG SP IGE; QUAN OR SEMIQUAN,30000018,CDM,302,RC,86003,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALLERG SP IGE; QUAN OR SEMIQUAN,30000018,CDM,302,RC,86003,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB ID; LEUKOCYTE AB,30000019,CDM,300,RC,86021,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COLD AGGLUTININ; SCREEN,30000020,CDM,302,RC,86156,HCPCS,facility,both,,,,27.22,27.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COLD AGGLUTININ; SCREEN,30000020,CDM,302,RC,86156,HCPCS,facility,both,,,,25.5,25.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COLD AGGLUTININ; TITER,30000021,CDM,300,RC,86157,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COLD AGGLUTININ; TITER,30000021,CDM,300,RC,86157,HCPCS,facility,both,,,,54.43,54.43,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ID; GEL QUAL; EA AB/AG,30000022,CDM,302,RC,86331,HCPCS,facility,both,,,,39.77,39.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ID; GEL QUAL; EA AB/AG,30000022,CDM,302,RC,86331,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LYMPHOCYTE MITOGEN RESPONSE,30000023,CDM,302,RC,86353,HCPCS,facility,both,,,,161.19,161.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NITROBLUE TETRAZOLIUM DYE TEST,30000024,CDM,302,RC,86384,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NITROBLUE TETRAZOLIUM DYE TEST,30000024,CDM,302,RC,86384,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HEMOPHILUS INFLUENZA,30000025,CDM,302,RC,86684,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HEMOPHILUS INFLUENZA,30000025,CDM,302,RC,86684,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HIV-2,30000026,CDM,302,RC,86702,HCPCS,facility,both,,,,40.5,40.5,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; HIV-2,30000026,CDM,302,RC,86702,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HIV-2,30000026,CDM,302,RC,86702,HCPCS,facility,both,,,,55.5,55.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC AB ELUTION EA,30000027,CDM,300,RC,86860,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC AB ELUTION EA,30000027,CDM,300,RC,86860,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB ID RBC EA PANEL EA TECHN,30000028,CDM,300,RC,86870,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB ID RBC EA PANEL EA TECHN,30000028,CDM,300,RC,86870,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COOMBS; DIRECT,30000029,CDM,300,RC,86880,HCPCS,facility,both,,,,16.5,16.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COOMBS; DIRECT,30000029,CDM,300,RC,86880,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC COOMBS; DIRECT,30000029,CDM,300,RC,86880,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COOMBS TEST INDIRECT TITER,30000030,CDM,300,RC,86886,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COOMBS TEST INDIRECT TITER,30000030,CDM,300,RC,86886,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC COOMBS TEST INDIRECT TITER,30000030,CDM,300,RC,86886,HCPCS,facility,both,,,,66.99,66.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD TYPING; ABO,30000031,CDM,300,RC,86900,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD TYPING; ABO,30000031,CDM,300,RC,86900,HCPCS,facility,both,,,,13,13,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD TYPING; RH D,30000032,CDM,300,RC,86901,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD TYPING; RH D,30000032,CDM,300,RC,86901,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD TYPE ANTIGEN DONOR EA,30000033,CDM,300,RC,86902,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD TYPE ANTIGEN DONOR EA,30000033,CDM,300,RC,86902,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLD TYPE; RBC AG NOT ABO/RHD,30000034,CDM,300,RC,86905,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLD TYPE; RBC AG NOT ABO/RHD,30000034,CDM,300,RC,86905,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLD TYPE; RH PHENOTYPE,30000035,CDM,300,RC,86906,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLD TYPE; RH PHENOTYPE,30000035,CDM,300,RC,86906,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPATIBILITY TEST ANTIGLOB,30000036,CDM,300,RC,86922,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPATIBILITY TEST ANTIGLOB,30000036,CDM,300,RC,86922,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPATIBILITY TEST ELECTRIC,30000037,CDM,300,RC,86923,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPATIBILITY TEST ELECTRIC,30000037,CDM,300,RC,86923,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IRRADIATE BLD PRODUCT EA UNIT,30000038,CDM,300,RC,86945,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IRRADIATE BLD PRODUCT EA UNIT,30000038,CDM,300,RC,86945,HCPCS,facility,both,,,,167.48,167.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VOL REDUCTION OF BLOOD/PROD,30000039,CDM,300,RC,86960,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VOL REDUCTION OF BLOOD/PROD,30000039,CDM,300,RC,86960,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POOL PLATELETS OR BLD PRODUCT,30000040,CDM,300,RC,86965,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POOL PLATELETS OR BLD PRODUCT,30000040,CDM,300,RC,86965,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PRETREAT RBC; ENZYMES,30000041,CDM,300,RC,86971,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PRETREAT RBC; ENZYMES,30000041,CDM,300,RC,86971,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SPLIT BLD PRODUCT EA UNIT,30000042,CDM,300,RC,86985,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SPLIT BLD PRODUCT EA UNIT,30000042,CDM,300,RC,86985,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIFF CELL COUNT NOT BLOOD,30000045,CDM,300,RC,89051,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIFF CELL COUNT NOT BLOOD,30000045,CDM,300,RC,89051,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIFF CELL COUNT NOT BLOOD,30000045,CDM,300,RC,89051,HCPCS,facility,both,,,,5.6,5.6,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC SEMEN ANAL STRICT CRITERIA,30000046,CDM,300,RC,89322,HCPCS,facility,both,,,,60.71,60.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKOREDUCTION,30000047,CDM,300,RC,86999,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKOREDUCTION,30000047,CDM,300,RC,86999,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TRICH. VAGINALIS AMP PROBE,30000048,CDM,306,RC,87661,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRICH. VAGINALIS AMP PROBE,30000048,CDM,306,RC,87661,HCPCS,facility,both,,,,71,71,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NFCT DS CHRNC HCV 6 ASSAYS (153),30000049,CDM,300,RC,81596,HCPCS,facility,both,,,,320.29,320.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NFCT DS CHRNC HCV 6 ASSAYS (153),30000049,CDM,300,RC,81596,HCPCS,facility,both,,,,295,295,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPATIBILITY TEST INCUBATE,30000101,CDM,300,RC,86921,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPATIBILITY TEST INCUBATE,30000101,CDM,300,RC,86921,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRETREAT RBC; CHEM OR DRUGS,30000102,CDM,300,RC,86970,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRETREAT RBC; CHEM OR DRUGS,30000102,CDM,300,RC,86970,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SERUM PRETX; RC ABSORPT,30000103,CDM,300,RC,86978,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SERUM PRETX; RC ABSORPT,30000103,CDM,300,RC,86978,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FECAL LEUKO CNT QUAL/SEMIQUAN,30000105,CDM,300,RC,89055,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FECAL LEUKO CNT QUAL/SEMIQUAN,30000105,CDM,300,RC,89055,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EXAM SYNOVIAL FLUID CRYSTALS,30000106,CDM,300,RC,89060,HCPCS,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EXAM SYNOVIAL FLUID CRYSTALS,30000106,CDM,300,RC,89060,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOLOG BLOOD OP SALVAGE,30000108,CDM,300,RC,86891,HCPCS,facility,both,,,,1099.06,1099.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MEAT FIBERS FECES,30000109,CDM,300,RC,89160,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLD TYPE; AG SCRN W PT SERUM,30000125,CDM,300,RC,86904,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL SCREEN,30000128,CDM,300,RC,86941,HCPCS,facility,both,,,,88.5,88.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FETAL SCREEN,30000128,CDM,300,RC,86941,HCPCS,facility,both,,,,37.68,37.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM PRETX; DILUTION,30000130,CDM,300,RC,86976,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SERUM PRETX; DILUTION,30000130,CDM,300,RC,86976,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM PRETX; INHIBITOR INCUBATE,30000131,CDM,300,RC,86977,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM PRETX; INHIBITOR INCUBATE,30000131,CDM,300,RC,86977,HCPCS,facility,both,,,,27.5,27.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SEMEN; MOTILITY & COUNT,30000150,CDM,300,RC,89310,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SEMEN ANAL VOL/COUNT/MOT,30000151,CDM,300,RC,89320,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SEMEN ANAL VOL/COUNT/MOT,30000151,CDM,300,RC,89320,HCPCS,facility,both,,,,60.71,60.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SEMEN ANAL VOL/COUNT/MOT,30000151,CDM,300,RC,89320,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC SEMEN ANAL SPERM DETECTION,30000152,CDM,300,RC,89321,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SEMEN ANAL SPERM DETECTION,30000152,CDM,300,RC,89321,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RETROGRADE EJACULATION ANAL,30000154,CDM,300,RC,89331,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RETROGRADE EJACULATION ANAL,30000154,CDM,300,RC,89331,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LAB ONE-WAY ALLOW PRORATED TRIP,30000161,CDM,300,RC,,,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (70),30000163,CDM,300,RC,83520,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC IMMUNOASSAY, NOS PART OF PANEL",30000164,CDM,300,RC,83520,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC IMMUNOASSAY, NOS PART OF PANEL",30000164,CDM,300,RC,83520,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (25),30000165,CDM,300,RC,83520,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (25),30000165,CDM,300,RC,83520,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (35),30000166,CDM,300,RC,83520,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (35),30000166,CDM,300,RC,83520,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (40),30000167,CDM,300,RC,83520,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (40),30000167,CDM,300,RC,83520,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (90),30000168,CDM,300,RC,83520,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (90),30000168,CDM,300,RC,83520,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (100),30000169,CDM,300,RC,83520,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (100),30000169,CDM,300,RC,83520,HCPCS,facility,both,,,,155,155,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (115),30000170,CDM,300,RC,83520,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (115),30000170,CDM,300,RC,83520,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (190),30000171,CDM,300,RC,83520,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (190),30000171,CDM,300,RC,83520,HCPCS,facility,both,,,,365,365,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (550),30000172,CDM,300,RC,83520,HCPCS,facility,both,,,,1151.39,1151.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (550),30000172,CDM,300,RC,83520,HCPCS,facility,both,,,,860,860,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (980),30000173,CDM,300,RC,83520,HCPCS,facility,both,,,,2051.57,2051.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (170),30000174,CDM,300,RC,83520,HCPCS,facility,both,,,,285,285,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (170),30000174,CDM,300,RC,83520,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (65),30000175,CDM,300,RC,83520,HCPCS,facility,both,,,,136.07,136.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (65),30000175,CDM,300,RC,83520,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (45),30000176,CDM,300,RC,83520,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (45),30000176,CDM,300,RC,83520,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED HEMAT/COAG  PROC (255),30000177,CDM,305,RC,85999,HCPCS,facility,both,,,,533.83,533.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED TRANSFUSION MED  PROC (425),30000178,CDM,300,RC,86999,HCPCS,facility,both,,,,889.71,889.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (240),30000179,CDM,300,RC,83520,HCPCS,facility,both,,,,405,405,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (240),30000179,CDM,300,RC,83520,HCPCS,facility,both,,,,502.42,502.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (130),30000180,CDM,300,RC,83520,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (130),30000180,CDM,300,RC,83520,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB,30000184,CDM,300,RC,83520,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC IAD BY NUCLEIC ACID (DNA OR RNA); BORRELIA MIYAMOTOI, APT (41)",30001856,CDM,300,RC,87478,HCPCS,facility,both,,,,85.83,85.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(12)",30001858,CDM,300,RC,83520,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(32)",30001859,CDM,300,RC,83520,HCPCS,facility,both,,,,66.99,66.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (184),30001860,CDM,300,RC,83520,HCPCS,facility,both,,,,385.19,385.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC H.PYLORI + CLARITHRO RESIST, PCR, F",30001861,CDM,300,RC,87513,HCPCS,facility,both,,,,96.3,96.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FACTOR XIII QUEST,30060007,CDM,300,RC,85290,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC LYME(B.BURGDORFERI)PCR,CSF QST",30060011,CDM,300,RC,87476,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POCT ASSAY PH BODY FLUID NOS,30070003,CDM,301,RC,83986,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POCT URINE HCG VISUAL COLOR,30070004,CDM,307,RC,81025,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POCT SMEAR - INFECTIOUS WET MOUNT,30070006,CDM,306,RC,87210,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POCT GLUCOSE; BLOOD REAGENT STRIP,30070007,CDM,301,RC,82948,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC POCT FERN TEST,30070008,CDM,301,RC,,,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LAB CHEMISTRY,30100000,CDM,301,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ELECTROLYTE PANEL,30100001,CDM,301,RC,80051,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ELECTROLYTE PANEL,30100001,CDM,301,RC,80051,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ELECTROLYTE PANEL,30100001,CDM,301,RC,80051,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ELECTROLYTE PANEL,30100001,CDM,301,RC,80051,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,13.39,13.39,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,39.77,39.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AMIKACIN,30100003,CDM,301,RC,80150,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMIKACIN,30100003,CDM,301,RC,80150,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC BENZODIAZEPINES, 1-12",30100005,CDM,301,RC,80346,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC BENZODIAZEPINES, 1-12",30100005,CDM,301,RC,80346,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARBAMAZEPINE; TOTAL,30100006,CDM,301,RC,80156,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARBAMAZEPINE; TOTAL,30100006,CDM,301,RC,80156,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CARBAMAZEPINE; TOTAL,30100006,CDM,301,RC,80156,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARBAMAZEPINE; FREE,30100007,CDM,301,RC,80157,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARBAMAZEPINE; FREE,30100007,CDM,301,RC,80157,HCPCS,facility,both,,,,50.75,50.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYCLOSPORINE,30100008,CDM,301,RC,80158,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYCLOSPORINE,30100008,CDM,301,RC,80158,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIGOXIN QUANTITATIVE,30100010,CDM,301,RC,80162,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIGOXIN QUANTITATIVE,30100010,CDM,301,RC,80162,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC DIGOXIN QUANTITATIVE,30100010,CDM,301,RC,80162,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIPROPYLACETIC ACID,30100011,CDM,301,RC,80164,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC DIPROPYLACETIC ACID,30100011,CDM,301,RC,80164,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIPROPYLACETIC ACID,30100011,CDM,301,RC,80164,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENTAMICIN,30100012,CDM,301,RC,80170,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENTAMICIN,30100012,CDM,301,RC,80170,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HALOPERIDOL ASSAY,30100013,CDM,301,RC,80173,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HALOPERIDOL ASSAY,30100013,CDM,301,RC,80173,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIDOCAINE,30100015,CDM,301,RC,80176,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIDOCAINE,30100015,CDM,301,RC,80176,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LITHIUM,30100016,CDM,301,RC,80178,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LITHIUM,30100016,CDM,301,RC,80178,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LITHIUM,30100016,CDM,301,RC,80178,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC PHENOBARBITAL,30100018,CDM,301,RC,80184,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PHENOBARBITAL,30100018,CDM,301,RC,80184,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENYTOIN; TOTAL,30100019,CDM,301,RC,80185,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PHENYTOIN; TOTAL,30100019,CDM,301,RC,80185,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENYTOIN; FREE,30100020,CDM,301,RC,80186,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PHENYTOIN; FREE,30100020,CDM,301,RC,80186,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRIMIDONE,30100021,CDM,301,RC,80188,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRIMIDONE,30100021,CDM,301,RC,80188,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROCAINAMIDE W METABOLITES,30100022,CDM,301,RC,80192,HCPCS,facility,both,,,,37.5,37.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROCAINAMIDE W METABOLITES,30100022,CDM,301,RC,80192,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUINIDINE,30100023,CDM,301,RC,80194,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUINIDINE,30100023,CDM,301,RC,80194,HCPCS,facility,both,,,,34.38,34.38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF SIROLIMUS,30100024,CDM,301,RC,80195,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF SIROLIMUS,30100024,CDM,301,RC,80195,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TACROLIMUS,30100026,CDM,301,RC,80197,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TACROLIMUS,30100026,CDM,301,RC,80197,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TACROLIMUS,30100026,CDM,301,RC,80197,HCPCS,facility,both,,,,13.73,13.73,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC THEOPHYLLINE,30100027,CDM,301,RC,80198,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THEOPHYLLINE,30100027,CDM,301,RC,80198,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOBRAMYCIN,30100028,CDM,301,RC,80200,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOBRAMYCIN,30100028,CDM,301,RC,80200,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOPIRAMATE,30100029,CDM,301,RC,80201,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOPIRAMATE,30100029,CDM,301,RC,80201,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VANCOMYCIN,30100030,CDM,301,RC,80202,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VANCOMYCIN,30100030,CDM,301,RC,80202,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VANCOMYCIN,30100030,CDM,301,RC,80202,HCPCS,facility,both,,,,13.54,13.54,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC DABIGATRAN ASSAY,30100031,CDM,301,RC,80299,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACETAZOLAMIDE (DIAMOX),30100032,CDM,301,RC,80299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BUPROPION,30100033,CDM,301,RC,80299,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ATAZANAVIR LEVEL SERUM,30100035,CDM,301,RC,80299,HCPCS,facility,both,,,,198.87,198.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ATAZANAVIR LEVEL SERUM,30100035,CDM,301,RC,80299,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ITRACONAZOLE, HPLC",30100036,CDM,301,RC,80299,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC KALETRA, QUANTITATION",30100037,CDM,301,RC,80299,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,18.84,18.84,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,15.91,15.91,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,11.5,11.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC N-AUTOM URINALYS WO MICRO,30100040,CDM,307,RC,81002,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC N-AUTOM URINALYS WO MICRO,30100040,CDM,307,RC,81002,HCPCS,facility,both,,,,6.5,6.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AUTOM URINALYSIS WO MICRO,30100041,CDM,307,RC,81003,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AUTOM URINALYSIS WO MICRO,30100041,CDM,307,RC,81003,HCPCS,facility,both,,,,5.5,5.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AUTOM URINALYSIS WO MICRO,30100041,CDM,307,RC,81003,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AUTOM URINALYSIS WO MICRO,30100041,CDM,307,RC,81003,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINALYSIS; QUAL NOT IA,30100042,CDM,307,RC,81005,HCPCS,facility,both,,,,46.5,46.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URINALYSIS; QUAL NOT IA,30100042,CDM,307,RC,81005,HCPCS,facility,both,,,,18.84,18.84,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINALYSIS - MICRO ONLY,30100043,CDM,307,RC,81015,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINALYSIS - MICRO ONLY,30100043,CDM,307,RC,81015,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANT SERUM ACETONES/KETONES,30100045,CDM,301,RC,82010,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANT SERUM ACETONES/KETONES,30100045,CDM,301,RC,82010,HCPCS,facility,both,,,,27.22,27.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACETYLCHOLINESTERASE,30100046,CDM,301,RC,82013,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACYLCARNITINES; QUAN,30100047,CDM,301,RC,82017,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ACYLCARNITINES; QUAN,30100047,CDM,301,RC,82017,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACTH,30100048,CDM,301,RC,82024,HCPCS,facility,both,,,,59,59,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ACTH,30100048,CDM,301,RC,82024,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ACTH,30100048,CDM,301,RC,82024,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF SERUM ALBUMIN,30100049,CDM,301,RC,82040,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF SERUM ALBUMIN,30100049,CDM,301,RC,82040,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ASSAY OF SERUM ALBUMIN,30100049,CDM,301,RC,82040,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALBUMIN; QUAN,30100050,CDM,301,RC,82042,HCPCS,facility,both,,,,37.75,37.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALBUMIN; QUAN,30100050,CDM,301,RC,82042,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALBUMIN; URINE QUANT,30100051,CDM,301,RC,82043,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALBUMIN; URINE QUANT,30100051,CDM,301,RC,82043,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALBUMIN; URINE QUANT,30100051,CDM,301,RC,82043,HCPCS,facility,both,,,,5.78,5.78,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC ALDOSTERONE,30100053,CDM,301,RC,82088,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALDOSTERONE,30100053,CDM,301,RC,82088,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALPHA-FETOPROTEIN SERUM,30100054,CDM,301,RC,82105,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALPHA-FETOPROTEIN SERUM,30100054,CDM,301,RC,82105,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALPHA-FETOPROTEIN AMNIOTIC,30100055,CDM,301,RC,82106,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALPHA-FETOPROTEIN AMNIOTIC,30100055,CDM,301,RC,82106,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMINO ACIDS; MULTI QUAL EA,30100056,CDM,301,RC,82128,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMINO ACIDS 6/>  QUAN EA,30100057,CDM,301,RC,82139,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMINO ACIDS 6/>  QUAN EA,30100057,CDM,301,RC,82139,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMMONIA,30100058,CDM,301,RC,82140,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMMONIA,30100058,CDM,301,RC,82140,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMYLASE,30100059,CDM,301,RC,82150,HCPCS,facility,both,,,,27.5,27.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMYLASE,30100059,CDM,301,RC,82150,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMYLASE,30100059,CDM,301,RC,82150,HCPCS,facility,both,,,,6.48,6.48,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AMYLASE,30100059,CDM,301,RC,82150,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ASCORBIC ACID BLOOD,30100060,CDM,301,RC,82180,HCPCS,facility,both,,,,47.5,47.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASCORBIC ACID BLOOD,30100060,CDM,301,RC,82180,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BARBITURATES,30100061,CDM,301,RC,80345,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BARBITURATES,30100061,CDM,301,RC,80345,HCPCS,facility,both,,,,31.5,31.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BETA-2 MICROGLOBULIN,30100062,CDM,301,RC,82232,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BETA-2 MICROGLOBULIN,30100062,CDM,301,RC,82232,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOTAL BILIRUBIN,30100063,CDM,301,RC,82247,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC TOTAL BILIRUBIN,30100063,CDM,301,RC,82247,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC TOTAL BILIRUBIN,30100063,CDM,301,RC,82247,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOTAL BILIRUBIN,30100063,CDM,301,RC,82247,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,20.5,20.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,5.02,5.02,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OCCULT BLOOD FECES,30100065,CDM,301,RC,82270,HCPCS,facility,both,,,,13,13,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OCCULT BLOOD FECES,30100065,CDM,301,RC,82270,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OCCULT BLD FHG QUAL 1-3,30100066,CDM,301,RC,82274,HCPCS,facility,both,,,,15.92,15.92,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC OCCULT BLD FHG QUAL 1-3,30100066,CDM,301,RC,82274,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OCCULT BLD FHG QUAL 1-3,30100066,CDM,301,RC,82274,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CADMIUM,30100067,CDM,301,RC,82300,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CADMIUM,30100067,CDM,301,RC,82300,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VITAMIN D 25 HYDROXY,30100068,CDM,301,RC,82306,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VITAMIN D 25 HYDROXY,30100068,CDM,301,RC,82306,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC VITAMIN D 25 HYDROXY,30100068,CDM,301,RC,82306,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN D 25 HYDROXY,30100068,CDM,301,RC,82306,HCPCS,facility,both,,,,29.6,29.6,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC CALCITONIN,30100069,CDM,301,RC,82308,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CALCITONIN,30100069,CDM,301,RC,82308,HCPCS,facility,both,,,,48.5,48.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,5.16,5.16,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CALCIUM; IONIZED,30100071,CDM,301,RC,82330,HCPCS,facility,both,,,,13.68,13.68,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC CALCIUM; IONIZED,30100071,CDM,301,RC,82330,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CALCIUM; IONIZED,30100071,CDM,301,RC,82330,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CALCIUM; IONIZED,30100071,CDM,301,RC,82330,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CALCIUM; URINE QUAN TIMED,30100072,CDM,301,RC,82340,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CALCIUM; URINE QUAN TIMED,30100072,CDM,301,RC,82340,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STONE; IR SPECTROSCOPY,30100073,CDM,301,RC,82365,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STONE; IR SPECTROSCOPY,30100073,CDM,301,RC,82365,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARBON DIOXIDE (CO2),30100074,CDM,301,RC,82374,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARBON DIOXIDE (CO2),30100074,CDM,301,RC,82374,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARBON DIOXIDE (CO2),30100074,CDM,301,RC,82374,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ASSAY CARBOXYHB QUANT,30100075,CDM,301,RC,82375,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY CARBOXYHB QUANT,30100075,CDM,301,RC,82375,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CEA,30100076,CDM,301,RC,82378,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CEA,30100076,CDM,301,RC,82378,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLORIDE; BLOOD,30100077,CDM,301,RC,82435,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC CHLORIDE; BLOOD,30100077,CDM,301,RC,82435,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHLORIDE; BLOOD,30100077,CDM,301,RC,82435,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLORIDE; URINE,30100078,CDM,301,RC,82436,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHLORIDE; URINE,30100078,CDM,301,RC,82436,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SERUM/WB TOT CHOLEST,30100079,CDM,301,RC,82465,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM/WB TOT CHOLEST,30100079,CDM,301,RC,82465,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC SERUM/WB TOT CHOLEST,30100079,CDM,301,RC,82465,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SERUM/WB TOT CHOLEST,30100079,CDM,301,RC,82465,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC C CHROMATOGR QUAN ANALYT NES,30100083,CDM,301,RC,82491,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC C CHROMATOGR QUAN ANALYT NES,30100083,CDM,301,RC,82491,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC C CHROMOTOGR QUAN; MULTI ANALY,30100084,CDM,301,RC,82492,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC C CHROMOTOGR QUAN; MULTI ANALY,30100084,CDM,301,RC,82492,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROMIUM,30100085,CDM,301,RC,82495,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROMIUM,30100085,CDM,301,RC,82495,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COLLAGEN CROSS LINKS,30100086,CDM,301,RC,82523,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COLLAGEN CROSS LINKS,30100086,CDM,301,RC,82523,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COLLAGEN CROSS LINKS,30100086,CDM,301,RC,82523,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC COPPER,30100087,CDM,301,RC,82525,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COPPER,30100087,CDM,301,RC,82525,HCPCS,facility,both,,,,82.69,82.69,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CORTICOSTERONE,30100088,CDM,301,RC,82528,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CORTISOL; FREE,30100089,CDM,301,RC,82530,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CORTISOL; FREE,30100089,CDM,301,RC,82530,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CORTISOL; TOTAL,30100090,CDM,301,RC,82533,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC CORTISOL; TOTAL,30100090,CDM,301,RC,82533,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CORTISOL; TOTAL,30100090,CDM,301,RC,82533,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CC/MS; QUAN SS & MP,30100091,CDM,301,RC,82542,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CC/MS; QUAN SS & MP,30100091,CDM,301,RC,82542,HCPCS,facility,both,,,,195,195,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CC/MS - SGL ANALYTE QUAN,30100092,CDM,301,RC,82543,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CC/MS - MULTI ANALYTES QUAN,30100093,CDM,301,RC,82544,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CPK; TOTAL,30100094,CDM,301,RC,82550,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CPK; TOTAL,30100094,CDM,301,RC,82550,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CPK; TOTAL,30100094,CDM,301,RC,82550,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CPK: MB FRACTION ONLY,30100095,CDM,301,RC,82553,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CPK: MB FRACTION ONLY,30100095,CDM,301,RC,82553,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CPK: MB FRACTION ONLY,30100095,CDM,301,RC,82553,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CREATININE; BLOOD,30100096,CDM,301,RC,82565,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC CREATININE; BLOOD,30100096,CDM,301,RC,82565,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CREATININE; BLOOD,30100096,CDM,301,RC,82565,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CREATININE; BLOOD,30100096,CDM,301,RC,82565,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CREATININE; NOT BLOOD,30100097,CDM,301,RC,82570,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CREATININE; NOT BLOOD,30100097,CDM,301,RC,82570,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CREATININE; NOT BLOOD,30100097,CDM,301,RC,82570,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CREATININE; NOT BLOOD,30100097,CDM,301,RC,82570,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC CREATININE; CLEARANCE,30100098,CDM,301,RC,82575,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CREATININE; CLEARANCE,30100098,CDM,301,RC,82575,HCPCS,facility,both,,,,22.5,22.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CRYOFIBRINOGEN,30100099,CDM,301,RC,82585,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CRYOFIBRINOGEN,30100099,CDM,301,RC,82585,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CRYOGLOBULIN - QUAL/SEMI QUAN,30100100,CDM,301,RC,82595,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CRYOGLOBULIN - QUAL/SEMI QUAN,30100100,CDM,301,RC,82595,HCPCS,facility,both,,,,26.5,26.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VITAMIN B-12 LEVEL,30100101,CDM,301,RC,82607,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN B-12 LEVEL,30100101,CDM,301,RC,82607,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VITAMIN B-12 LEVEL,30100101,CDM,301,RC,82607,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC VITAMIN B-12 LEVEL,30100101,CDM,301,RC,82607,HCPCS,facility,both,,,,15.08,15.08,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC CYSTATIN C,30100102,CDM,301,RC,82610,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYSTATIN C,30100102,CDM,301,RC,82610,HCPCS,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIT D 1 25-DIHYDROXY,30100103,CDM,301,RC,82652,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VIT D 1 25-DIHYDROXY,30100103,CDM,301,RC,82652,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC VIT D 1 25-DIHYDROXY,30100103,CDM,301,RC,82652,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PANCREATIC ELASTASE FECAL,30100104,CDM,301,RC,82656,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PANCREATIC ELASTASE FECAL,30100104,CDM,301,RC,82656,HCPCS,facility,both,,,,310,310,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN",30100105,CDM,301,RC,82657,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN",30100105,CDM,301,RC,82657,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTRADIOL; TOTAL,30100106,CDM,301,RC,82670,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ESTRADIOL; TOTAL,30100106,CDM,301,RC,82670,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ESTRADIOL; TOTAL,30100106,CDM,301,RC,82670,HCPCS,facility,both,,,,205,205,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTRIOL UNCONJUGATED,30100107,CDM,301,RC,82677,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTRIOL UNCONJUGATED,30100107,CDM,301,RC,82677,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FAT/LIPIDS FECES; QUAN,30100108,CDM,301,RC,82710,HCPCS,facility,both,,,,36.75,36.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FAT/LIPIDS FECES; QUAN,30100108,CDM,301,RC,82710,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FERRITIN,30100109,CDM,301,RC,82728,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FERRITIN,30100109,CDM,301,RC,82728,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC FERRITIN,30100109,CDM,301,RC,82728,HCPCS,facility,both,,,,13.63,13.63,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC FERRITIN,30100109,CDM,301,RC,82728,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL FIBRONECTIN CV SEMIQUAN,30100110,CDM,301,RC,82731,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FETAL FIBRONECTIN CV SEMIQUAN,30100110,CDM,301,RC,82731,HCPCS,facility,both,,,,366.35,366.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FOLIC ACID; SERUM,30100111,CDM,301,RC,82746,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FOLIC ACID; SERUM,30100111,CDM,301,RC,82746,HCPCS,facility,both,,,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC FOLIC ACID; SERUM,30100111,CDM,301,RC,82746,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC FOLIC ACID; SERUM,30100111,CDM,301,RC,82746,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FOLIC ACID; RBC,30100112,CDM,301,RC,82747,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FOLIC ACID; RBC,30100112,CDM,301,RC,82747,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FRUCTOSE SEMEN,30100113,CDM,301,RC,82757,HCPCS,facility,both,,,,82.5,82.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FRUCTOSE SEMEN,30100113,CDM,301,RC,82757,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY IGA/IGD/IGG/IGM EACH,30100114,CDM,301,RC,82784,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ASSAY IGA/IGD/IGG/IGM EACH,30100114,CDM,301,RC,82784,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY IGA/IGD/IGG/IGM EACH,30100114,CDM,301,RC,82784,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGG 1 2 3 OR 4 EACH,30100115,CDM,301,RC,82787,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD GAS MIXED WO O2 SAT,30100116,CDM,301,RC,82803,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD GAS MIXED WO O2 SAT,30100116,CDM,301,RC,82803,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD GASES W/02 SATURATION,30100117,CDM,301,RC,82805,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD GASES W/02 SATURATION,30100117,CDM,301,RC,82805,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD GASES O2 SAT ONLY,30100118,CDM,301,RC,82810,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD GASES O2 SAT ONLY,30100118,CDM,301,RC,82810,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOGLOBIN-OXYGEN AFFINITY,30100119,CDM,301,RC,82820,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOGLOBIN-OXYGEN AFFINITY,30100119,CDM,301,RC,82820,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCOSE BODY FLUID NOT BLOOD,30100120,CDM,301,RC,82945,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCOSE BODY FLUID NOT BLOOD,30100120,CDM,301,RC,82945,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLUCOSE BODY FLUID NOT BLOOD,30100120,CDM,301,RC,82945,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,3.93,3.93,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLUCOSE; POST GLUCOSE DOSE,30100122,CDM,301,RC,82950,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLUCOSE; POST GLUCOSE DOSE,30100122,CDM,301,RC,82950,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM,30100123,CDM,301,RC,82951,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM,30100123,CDM,301,RC,82951,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GTT-ADDED SAMPLES,30100124,CDM,301,RC,82952,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GTT-ADDED SAMPLES,30100124,CDM,301,RC,82952,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLUTAMYLTRANSFERASE GAMMA,30100126,CDM,301,RC,82977,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLUTAMYLTRANSFERASE GAMMA,30100126,CDM,301,RC,82977,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC GLUTAMYLTRANSFERASE GAMMA,30100126,CDM,301,RC,82977,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC GLUTAMYLTRANSFERASE GAMMA,30100126,CDM,301,RC,82977,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GROWTH HORMONE HUMAN,30100127,CDM,301,RC,83003,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GROWTH HORMONE HUMAN,30100127,CDM,301,RC,83003,HCPCS,facility,both,,,,66.99,66.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HAPTOGLOBIN; QUAN,30100128,CDM,301,RC,83010,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HAPTOGLOBIN; QUAN,30100128,CDM,301,RC,83010,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEAVY METAL; QUAN,30100129,CDM,301,RC,83018,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEAVY METAL; QUAN,30100129,CDM,301,RC,83018,HCPCS,facility,both,,,,72.5,72.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HGB FRACT & QUAN; EP,30100130,CDM,301,RC,83020,HCPCS,facility,both,,,,59.5,59.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HGB FRACT & QUAN; EP,30100130,CDM,301,RC,83020,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HGB CHROMATOGRAPHY,30100131,CDM,301,RC,83021,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HGB CHROMATOGRAPHY,30100131,CDM,301,RC,83021,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HGB; FETAL CHEMICAL,30100132,CDM,301,RC,83030,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HGB; FETAL CHEMICAL,30100132,CDM,301,RC,83030,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HGB; FETAL QUAL,30100133,CDM,301,RC,83033,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HGB; FETAL QUAL,30100133,CDM,301,RC,83033,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,9.71,9.71,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HBG; METHEMOGLOBIN QUAN,30100135,CDM,301,RC,83050,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HBG; METHEMOGLOBIN QUAN,30100135,CDM,301,RC,83050,HCPCS,facility,both,,,,60.5,60.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOGLOBIN; UNSTABLE SCREEN,30100136,CDM,301,RC,83068,HCPCS,facility,both,,,,27.22,27.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEMOGLOBIN; UNSTABLE SCREEN,30100136,CDM,301,RC,83068,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOSIDERIN; QUAL,30100137,CDM,301,RC,83070,HCPCS,facility,both,,,,25.07,25.07,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOSIDERIN; QUAL,30100137,CDM,301,RC,83070,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC B-HEXOSAMINIDASE EA ASSAY,30100138,CDM,301,RC,83080,HCPCS,facility,both,,,,223.25,223.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC B-HEXOSAMINIDASE EA ASSAY,30100138,CDM,301,RC,83080,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF HOMOCYSTINE,30100139,CDM,301,RC,83090,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF HOMOCYSTINE,30100139,CDM,301,RC,83090,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC 5-HIAA,30100140,CDM,301,RC,83497,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC 5-HIAA,30100140,CDM,301,RC,83497,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY NONANTIBODY,30100141,CDM,301,RC,83516,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY NONANTIBODY,30100141,CDM,301,RC,83516,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RIA NONANTIBODY,30100142,CDM,301,RC,83519,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RIA NONANTIBODY,30100142,CDM,301,RC,83519,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY QUANT NOS NONAB (20),30100143,CDM,301,RC,83520,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY QUANT NOS NONAB (20),30100143,CDM,301,RC,83520,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (25),30100144,CDM,301,RC,83520,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (25),30100144,CDM,301,RC,83520,HCPCS,facility,both,,,,51.78,51.78,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SUBSTANCE P,30100147,CDM,301,RC,83520,HCPCS,facility,both,,,,100.48,100.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INTERLEUKIN 1 BETA,30100148,CDM,301,RC,83520,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTHROMBIN FRAGMENT 1.2,30100149,CDM,301,RC,83520,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTHROMBIN FRAGMENT 1.2,30100149,CDM,301,RC,83520,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY QUANT NOS NONAB (80),30100150,CDM,301,RC,83520,HCPCS,facility,both,,,,167.48,167.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (80),30100150,CDM,301,RC,83520,HCPCS,facility,both,,,,340,340,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC INTERLEUKIN-2, CIRCULATING",30100151,CDM,301,RC,83520,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC INTERLEUKIN-2, CIRCULATING",30100151,CDM,301,RC,83520,HCPCS,facility,both,,,,177.94,177.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ADAMSTS 13 ANTIBODY,30100152,CDM,301,RC,83520,HCPCS,facility,both,,,,92.11,92.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (94),30100153,CDM,301,RC,83520,HCPCS,facility,both,,,,196.78,196.78,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (94),30100153,CDM,301,RC,83520,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HACA ASSESSMENT,30100154,CDM,301,RC,83520,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RNA POLYMERASE I-III IGG,30100155,CDM,301,RC,83520,HCPCS,facility,both,,,,221.9,221.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RNA POLYMERASE I-III IGG,30100155,CDM,301,RC,83520,HCPCS,facility,both,,,,205,205,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
DEAC 2/8/2017 HC MAG ISM IGM AB EIA,30100156,CDM,301,RC,83520,HCPCS,facility,both,,,,268.91,268.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMALL FIBER AXONAL PROFILE,30100157,CDM,301,RC,83520,HCPCS,facility,both,,,,259.4,259.4,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SMALL FIBER AXONAL PROFILE,30100157,CDM,301,RC,83520,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HU RECOMBX ANTIBODY TEST,30100158,CDM,301,RC,83520,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HU RECOMBX ANTIBODY TEST,30100158,CDM,301,RC,83520,HCPCS,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY QUANT NOS NONAB (180),30100159,CDM,301,RC,83520,HCPCS,facility,both,,,,376.81,376.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (180),30100159,CDM,301,RC,83520,HCPCS,facility,both,,,,308.75,308.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SULFATIDE ANTIBODY TEST,30100160,CDM,301,RC,83520,HCPCS,facility,both,,,,387.29,387.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SULFATIDE ANTIBODY TEST,30100160,CDM,301,RC,83520,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FACTOR H AUTOANTIBODIES,30100161,CDM,301,RC,83520,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI IGA, TRANSFUSION MED",30100162,CDM,301,RC,83520,HCPCS,facility,both,,,,450.09,450.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI IGA, TRANSFUSION MED",30100162,CDM,301,RC,83520,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GANGLIONIC NACHR ANTIBODY,30100163,CDM,301,RC,83520,HCPCS,facility,both,,,,471.02,471.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VGKC ANTIBODY TEST,30100164,CDM,301,RC,83520,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VGKC ANTIBODY TEST,30100164,CDM,301,RC,83520,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CO-GM1 TRIAD AUTOANTIBODY,30100165,CDM,301,RC,83520,HCPCS,facility,both,,,,460,460,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CO-GM1 TRIAD AUTOANTIBODY,30100165,CDM,301,RC,83520,HCPCS,facility,both,,,,491.96,491.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IBD GENERATION II,30100166,CDM,301,RC,83520,HCPCS,facility,both,,,,586.16,586.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACHR/MUSK REFLEX ANTIBODY,30100167,CDM,301,RC,83520,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHOSPHO-TAU/AB42 CSF ANAL,30100168,CDM,301,RC,83520,HCPCS,facility,both,,,,868.77,868.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MUSK QUANTITATIVE ANTIBODY,30100169,CDM,301,RC,83520,HCPCS,facility,both,,,,931.58,931.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CO-GM1 QUATTRO ANTIBODIES (4),30100170,CDM,301,RC,83520,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CO-GM1 QUATTRO ANTIBODIES (4),30100170,CDM,301,RC,83520,HCPCS,facility,both,,,,1046.72,1046.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACHR/MUSK QUANTITATIVE AB,30100171,CDM,301,RC,83520,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOTOR NEUROPATHY PRO-COMP,30100172,CDM,301,RC,83520,HCPCS,facility,both,,,,1256.06,1256.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PARANEOPLASTIC PROFILE,30100173,CDM,301,RC,83520,HCPCS,facility,both,,,,1946.89,1946.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IRON,30100175,CDM,301,RC,83540,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IRON,30100175,CDM,301,RC,83540,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IRON,30100175,CDM,301,RC,83540,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC IRON,30100175,CDM,301,RC,83540,HCPCS,facility,both,,,,6.47,6.47,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC LACTATE,30100176,CDM,301,RC,83605,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC LACTATE,30100176,CDM,301,RC,83605,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LACTATE,30100176,CDM,301,RC,83605,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LACTATE DEHYDROGENASE,30100177,CDM,301,RC,83615,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC LACTATE DEHYDROGENASE,30100177,CDM,301,RC,83615,HCPCS,facility,both,,,,15.5,15.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LACTATE DEHYDROGENASE,30100177,CDM,301,RC,83615,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LACTATE DEHYDROGENASE,30100177,CDM,301,RC,83615,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC LACTOFERRIN FECAL (QUAL),30100178,CDM,301,RC,83630,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LACTOFERRIN FECAL (QUAL),30100178,CDM,301,RC,83630,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEAD,30100179,CDM,301,RC,83655,HCPCS,facility,both,,,,12.11,12.11,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC LEAD,30100179,CDM,301,RC,83655,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEAD,30100179,CDM,301,RC,83655,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FETAL LUNG - LB DENSITY,30100181,CDM,301,RC,83664,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL LUNG - LB DENSITY,30100181,CDM,301,RC,83664,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIPASE,30100182,CDM,301,RC,83690,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPASE,30100182,CDM,301,RC,83690,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIPASE,30100182,CDM,301,RC,83690,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ASSAY OF LIPOPROTEIN(A),30100183,CDM,301,RC,83695,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ASSAY OF LIPOPROTEIN(A),30100183,CDM,301,RC,83695,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF LIPOPROTEIN(A),30100183,CDM,301,RC,83695,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPOPROTEIN BLD HR FRACTION,30100184,CDM,301,RC,83701,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPOPROTEIN BLD BY NMR,30100185,CDM,301,RC,83704,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPOPROTEIN BLD BY NMR,30100185,CDM,301,RC,83704,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIPOPROTEIN; HDL,30100186,CDM,301,RC,83718,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LIPOPROTEIN; HDL,30100186,CDM,301,RC,83718,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC LIPOPROTEIN; HDL,30100186,CDM,301,RC,83718,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF BLOOD LIPOPROTEIN LDL,30100187,CDM,301,RC,83721,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF BLOOD LIPOPROTEIN LDL,30100187,CDM,301,RC,83721,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF BLOOD LIPOPROTEIN LDL,30100187,CDM,301,RC,83721,HCPCS,facility,both,,,,10.5,10.5,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,15.91,15.91,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,6.7,6.7,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC QUALIT MASS SPECT EA SPECIM,30100189,CDM,301,RC,83788,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUALIT MASS SPECT EA SPECIM,30100189,CDM,301,RC,83788,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN",30100190,CDM,301,RC,83789,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN",30100190,CDM,301,RC,83789,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN",30100190,CDM,301,RC,83789,HCPCS,facility,both,,,,24.11,24.11,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC METANEPHRINES,30100191,CDM,301,RC,83835,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC METANEPHRINES,30100191,CDM,301,RC,83835,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MUCOPOLYSACCH ACID; QUAN,30100193,CDM,301,RC,83864,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYOGLOBIN,30100195,CDM,301,RC,83874,HCPCS,facility,both,,,,51.75,51.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MYOGLOBIN,30100195,CDM,301,RC,83874,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NATRIURETIC PEPTIDE,30100196,CDM,301,RC,83880,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC NATRIURETIC PEPTIDE,30100196,CDM,301,RC,83880,HCPCS,facility,both,,,,39.26,39.26,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC NATRIURETIC PEPTIDE,30100196,CDM,301,RC,83880,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NATRIURETIC PEPTIDE,30100196,CDM,301,RC,83880,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF NUCLEOTIDASE,30100412,CDM,301,RC,83915,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF NUCLEOTIDASE,30100412,CDM,301,RC,83915,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OLIGOCLONAL BANDS,30100413,CDM,301,RC,83916,HCPCS,facility,both,,,,80.5,80.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OLIGOCLONAL BANDS,30100413,CDM,301,RC,83916,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN,30100414,CDM,301,RC,83918,HCPCS,facility,both,,,,261.68,261.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN,30100414,CDM,301,RC,83918,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ORGANIC ACID  SINGLE QUANTITATIVE,30100415,CDM,301,RC,83921,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ORGANIC ACID  SINGLE QUANTITATIVE,30100415,CDM,301,RC,83921,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OPIATES 1 OR MORE,30100416,CDM,301,RC,80361,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD OSMOLALITY,30100417,CDM,301,RC,83930,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD OSMOLALITY,30100417,CDM,301,RC,83930,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OSMOLALITY; URINE,30100418,CDM,301,RC,83935,HCPCS,facility,both,,,,36.5,36.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OSMOLALITY; URINE,30100418,CDM,301,RC,83935,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC OSMOLALITY; URINE,30100418,CDM,301,RC,83935,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PARATHORMONE,30100419,CDM,301,RC,83970,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PARATHORMONE,30100419,CDM,301,RC,83970,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PARATHORMONE,30100419,CDM,301,RC,83970,HCPCS,facility,both,,,,41.28,41.28,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC ASSAY FOR CALPROTECTIN FECAL,30100420,CDM,301,RC,83993,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY FOR CALPROTECTIN FECAL,30100420,CDM,301,RC,83993,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY FOR CALPROTECTIN FECAL,30100420,CDM,301,RC,83993,HCPCS,facility,both,,,,19.63,19.63,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
"HC ANTIPSYCHOTIC, NOS 1-3",30100421,CDM,301,RC,80342,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENYLALANINE BLOOD,30100422,CDM,301,RC,84030,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROSTATIC ACID PHOSPHATASE,30100423,CDM,301,RC,84066,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROSTATIC ACID PHOSPHATASE,30100423,CDM,301,RC,84066,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALKALINE PHOSPHATASE,30100424,CDM,301,RC,84075,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALKALINE PHOSPHATASE,30100424,CDM,301,RC,84075,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ALKALINE PHOSPHATASE,30100424,CDM,301,RC,84075,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ALKALINE PHOSPHATASE,30100424,CDM,301,RC,84075,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HT STBL ALKALINE PHOSPHATASE,30100425,CDM,301,RC,84078,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,4.74,4.74,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC URINE PHOSPHATE,30100427,CDM,301,RC,84105,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URINE PHOSPHATE,30100427,CDM,301,RC,84105,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PORPHOBILINOGEN URINE; QUAL,30100428,CDM,301,RC,84106,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PORPHOBILINOGEN URINE; QUAL,30100428,CDM,301,RC,84106,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,4.76,4.76,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC URINE POTASSIUM,30100430,CDM,301,RC,84133,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC URINE POTASSIUM,30100430,CDM,301,RC,84133,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINE POTASSIUM,30100430,CDM,301,RC,84133,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREALBUMIN,30100431,CDM,301,RC,84134,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREALBUMIN,30100431,CDM,301,RC,84134,HCPCS,facility,both,,,,14.59,14.59,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC PREALBUMIN,30100431,CDM,301,RC,84134,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC PREALBUMIN,30100431,CDM,301,RC,84134,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROLACTIN ASSAY,30100432,CDM,301,RC,84146,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROLACTIN ASSAY,30100432,CDM,301,RC,84146,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROLACTIN ASSAY,30100432,CDM,301,RC,84146,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC PSA; TOTAL,30100433,CDM,301,RC,84153,HCPCS,facility,both,,,,18.39,18.39,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC PSA; TOTAL,30100433,CDM,301,RC,84153,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC PSA; TOTAL,30100433,CDM,301,RC,84153,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PSA; TOTAL,30100433,CDM,301,RC,84153,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PSA; FREE,30100434,CDM,301,RC,84154,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PSA; FREE,30100434,CDM,301,RC,84154,HCPCS,facility,both,,,,18.39,18.39,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC PSA; FREE,30100434,CDM,301,RC,84154,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF PROTEIN SERUM,30100435,CDM,301,RC,84155,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ASSAY OF PROTEIN SERUM,30100435,CDM,301,RC,84155,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ASSAY OF PROTEIN SERUM,30100435,CDM,301,RC,84155,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF PROTEIN SERUM,30100435,CDM,301,RC,84155,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URINE TOTAL PROTEIN,30100436,CDM,301,RC,84156,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINE TOTAL PROTEIN,30100436,CDM,301,RC,84156,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC URINE TOTAL PROTEIN,30100436,CDM,301,RC,84156,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOTAL PROTEIN OTHER SPECIMEN,30100437,CDM,301,RC,84157,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOTAL PROTEIN OTHER SPECIMEN,30100437,CDM,301,RC,84157,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC TOTAL PROTEIN OTHER SPECIMEN,30100437,CDM,301,RC,84157,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTEIN; EP FRACT & QUAN,30100438,CDM,301,RC,84165,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTEIN; EP FRACT & QUAN,30100438,CDM,301,RC,84165,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTEIN E-PHORESIS/URINE/CSF,30100439,CDM,301,RC,84166,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTEIN E-PHORESIS/URINE/CSF,30100439,CDM,301,RC,84166,HCPCS,facility,both,,,,93,93,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTEIN WESTERN BLOT,30100440,CDM,301,RC,84181,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTEIN WESTERN BLOT,30100440,CDM,301,RC,84181,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTEIN WB; IM ID FOR BANDS,30100441,CDM,301,RC,84182,HCPCS,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTEIN WB; IM ID FOR BANDS,30100441,CDM,301,RC,84182,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RENIN,30100442,CDM,301,RC,84244,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RENIN,30100442,CDM,301,RC,84244,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF RIBOFLAVIN (VITAMIN B-2),30100443,CDM,301,RC,84252,HCPCS,facility,both,,,,85.9,85.9,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF RIBOFLAVIN (VITAMIN B-2),30100443,CDM,301,RC,84252,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SELENIUM,30100444,CDM,301,RC,84255,HCPCS,facility,both,,,,60.5,60.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SELENIUM,30100444,CDM,301,RC,84255,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF SERUM SODIUM,30100445,CDM,301,RC,84295,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC ASSAY OF SERUM SODIUM,30100445,CDM,301,RC,84295,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF SERUM SODIUM,30100445,CDM,301,RC,84295,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF SERUM SODIUM,30100445,CDM,301,RC,84295,HCPCS,facility,both,,,,4.81,4.81,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC SODIUM; URINE,30100446,CDM,301,RC,84300,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SODIUM; URINE,30100446,CDM,301,RC,84300,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SODIUM; URINE,30100446,CDM,301,RC,84300,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC SODIUM OTHER SOURCE,30100447,CDM,301,RC,84302,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SODIUM OTHER SOURCE,30100447,CDM,301,RC,84302,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SOMATOMEDIN,30100448,CDM,301,RC,84305,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC SOMATOMEDIN,30100448,CDM,301,RC,84305,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC SOMATOMEDIN,30100448,CDM,301,RC,84305,HCPCS,facility,both,,,,86.75,86.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SOMATOMEDIN,30100448,CDM,301,RC,84305,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SPECTROPHOTOMETRY ANALYTE NES,30100449,CDM,301,RC,84311,HCPCS,facility,both,,,,870,870,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SPECTROPHOTOMETRY ANALYTE NES,30100449,CDM,301,RC,84311,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SUGARS CHROMOTOGR TLC/PAPER,30100450,CDM,301,RC,84375,HCPCS,facility,both,,,,253.31,253.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SUGARS CHROMOTOGR TLC/PAPER,30100450,CDM,301,RC,84375,HCPCS,facility,both,,,,252,252,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URINE SULFATE,30100451,CDM,301,RC,84392,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URINE SULFATE,30100451,CDM,301,RC,84392,HCPCS,facility,both,,,,87.93,87.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TESTOSTERONE; FREE,30100452,CDM,301,RC,84402,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THIOCYANATE,30100453,CDM,301,RC,84430,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THIOCYANATE,30100453,CDM,301,RC,84430,HCPCS,facility,both,,,,71.5,71.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THROMBOXANE URINE,30100454,CDM,301,RC,84431,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THROMBOXANE URINE,30100454,CDM,301,RC,84431,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THYROGLOBULIN,30100455,CDM,301,RC,84432,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THYROGLOBULIN,30100455,CDM,301,RC,84432,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THYROGLOBULIN,30100455,CDM,301,RC,84432,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC THYROXINE; TOTAL,30100456,CDM,301,RC,84436,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC THYROXINE; TOTAL,30100456,CDM,301,RC,84436,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC THYROXINE; TOTAL,30100456,CDM,301,RC,84436,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THYROXINE; TOTAL,30100456,CDM,301,RC,84436,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FREE THYROXINE,30100457,CDM,301,RC,84439,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FREE THYROXINE,30100457,CDM,301,RC,84439,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FREE THYROXINE,30100457,CDM,301,RC,84439,HCPCS,facility,both,,,,9.02,9.02,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC FREE THYROXINE,30100457,CDM,301,RC,84439,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC THYROXINE BINDING GLOBULIN,30100458,CDM,301,RC,84442,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THYROXINE BINDING GLOBULIN,30100458,CDM,301,RC,84442,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,16.8,16.8,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,15.91,15.91,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AST OR SGOT,30100461,CDM,301,RC,84450,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AST OR SGOT,30100461,CDM,301,RC,84450,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AST OR SGOT,30100461,CDM,301,RC,84450,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AST OR SGOT,30100461,CDM,301,RC,84450,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRANSFERASE; ALANINE AMINO,30100462,CDM,301,RC,84460,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TRANSFERASE; ALANINE AMINO,30100462,CDM,301,RC,84460,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC TRANSFERASE; ALANINE AMINO,30100462,CDM,301,RC,84460,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC TRANSFERASE; ALANINE AMINO,30100462,CDM,301,RC,84460,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRANSFERRIN,30100463,CDM,301,RC,84466,HCPCS,facility,both,,,,12.76,12.76,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC TRANSFERRIN,30100463,CDM,301,RC,84466,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRANSFERRIN,30100463,CDM,301,RC,84466,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TRIGLYCERIDES,30100464,CDM,301,RC,84478,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRIGLYCERIDES,30100464,CDM,301,RC,84478,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TRIGLYCERIDES,30100464,CDM,301,RC,84478,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC T3 OR T4 OR THBR,30100465,CDM,301,RC,84479,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC T3 OR T4 OR THBR,30100465,CDM,301,RC,84479,HCPCS,facility,both,,,,22.75,22.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T3; TOTAL,30100466,CDM,301,RC,84480,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC T3; TOTAL,30100466,CDM,301,RC,84480,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC T3; TOTAL,30100466,CDM,301,RC,84480,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TROPONIN QUAN,30100467,CDM,301,RC,84484,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TROPONIN QUAN,30100467,CDM,301,RC,84484,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TROPONIN QUAN,30100467,CDM,301,RC,84484,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC UREA NITROGEN; QUAN,30100468,CDM,301,RC,84520,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC UREA NITROGEN; QUAN,30100468,CDM,301,RC,84520,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC UREA NITROGEN; QUAN,30100468,CDM,301,RC,84520,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UREA NITROGEN; QUAN,30100468,CDM,301,RC,84520,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UREA NITROGEN URINE,30100469,CDM,301,RC,84540,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UREA NITROGEN URINE,30100469,CDM,301,RC,84540,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,4.49,4.49,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC URIC ACID; NOT BLOOD,30100471,CDM,301,RC,84560,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URIC ACID; NOT BLOOD,30100471,CDM,301,RC,84560,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UROBILINOGEN URINE; QUAL,30100472,CDM,301,RC,84578,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UROBILINOGEN URINE; QUAL,30100472,CDM,301,RC,84578,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VMA URINE,30100473,CDM,301,RC,84585,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VMA URINE,30100473,CDM,301,RC,84585,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN NOS,30100474,CDM,301,RC,84591,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VITAMIN NOS,30100474,CDM,301,RC,84591,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN K,30100475,CDM,301,RC,84597,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN K,30100475,CDM,301,RC,84597,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VOLATILES,30100476,CDM,301,RC,84600,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC VOLATILES,30100476,CDM,301,RC,84600,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VOLATILES,30100476,CDM,301,RC,84600,HCPCS,facility,both,,,,38.5,38.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC XYLOSE ABSORPTION BLOOD &/OR URINE,30100477,CDM,301,RC,84620,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC XYLOSE ABSORPTION BLOOD &/OR URINE,30100477,CDM,301,RC,84620,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ZINC,30100478,CDM,301,RC,84630,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ZINC,30100478,CDM,301,RC,84630,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC C-PEPTIDE,30100479,CDM,301,RC,84681,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC C-PEPTIDE,30100479,CDM,301,RC,84681,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,50.25,50.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,15.05,15.05,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC UNLISTED CHEMISTRY (10),30100481,CDM,301,RC,84999,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED CHEMISTRY (10),30100481,CDM,301,RC,84999,HCPCS,facility,both,,,,36.5,36.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED CHEMISTRY TEST,30100483,CDM,301,RC,84999,HCPCS,facility,both,,,,465,465,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED CHEMISTRY TEST,30100483,CDM,301,RC,84999,HCPCS,facility,both,,,,634.31,634.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IA QUANT; CA 15-3 (27.29),30100484,CDM,302,RC,86300,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA QUANT; CA 15-3 (27.29),30100484,CDM,302,RC,86300,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INHIBIN A,30100485,CDM,302,RC,86336,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INHIBIN A,30100485,CDM,302,RC,86336,HCPCS,facility,both,,,,50.25,50.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN QUANT CAFFEINE,30100494,CDM,301,RC,80155,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN QUANT CLOZAPINE,30100495,CDM,301,RC,80159,HCPCS,facility,both,,,,37.75,37.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREEN QUANT CLOZAPINE,30100495,CDM,301,RC,80159,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN QUANT EVEROLIMUS,30100496,CDM,301,RC,80169,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN QUANT EVEROLIMUS,30100496,CDM,301,RC,80169,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREEN QUANT GABAPENTIN,30100497,CDM,301,RC,80171,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN QUAN LAMOTRIGINE,30100498,CDM,301,RC,80175,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCRN QUAN LEVETIRACETAM,30100499,CDM,301,RC,80177,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCRN QUAN MYCOPHENOLATE,30100500,CDM,301,RC,80180,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCRN QUANT OXCARBAZEPIN,30100501,CDM,301,RC,80183,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN QUANT ZONISAMIDE,30100503,CDM,301,RC,80203,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DMD DUP/DELET ANALYSIS,30100506,CDM,310,RC,81161,HCPCS,facility,both,,,,931.58,931.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASPA GENE,30100507,CDM,310,RC,81200,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC APC GENE KNOWN FAM VARIANTS,30100508,CDM,310,RC,81202,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL1 GENE MAJOR BP,30100509,CDM,310,RC,81206,HCPCS,facility,both,,,,508.71,508.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL1 GENE MINOR BP,30100510,CDM,310,RC,81207,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL1 GENE OTHER BP,30100511,CDM,310,RC,81208,HCPCS,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLM GENE,30100512,CDM,310,RC,81209,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLM GENE,30100512,CDM,310,RC,81209,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BRAF GENE,30100513,CDM,310,RC,81210,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYP2D6 GENE COM VARIANTS,30100519,CDM,310,RC,81226,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYP2D6 GENE COM VARIANTS,30100519,CDM,310,RC,81226,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYP2C9 GENE COM VARIANTS,30100520,CDM,310,RC,81227,HCPCS,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN M ARRAY COPY NO&SNP,30100522,CDM,310,RC,81229,HCPCS,facility,both,,,,735,735,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EGFR GENE COM VARIANTS,30100523,CDM,310,RC,81235,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FMR1 GENE DETECTION,30100525,CDM,310,RC,81243,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FMR1 GENE DETECTION,30100525,CDM,310,RC,81243,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLT3 GENE,30100527,CDM,310,RC,81245,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC G6PC GENE,30100528,CDM,310,RC,81250,HCPCS,facility,both,,,,525,525,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC G6PC GENE,30100528,CDM,310,RC,81250,HCPCS,facility,both,,,,795.51,795.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GJB2 GENE FULL SEQUENCE,30100530,CDM,310,RC,81252,HCPCS,facility,both,,,,753.64,753.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GJB2 GENE FULL SEQUENCE,30100530,CDM,310,RC,81252,HCPCS,facility,both,,,,700,700,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GJB6 GENE COM VARIANTS,30100531,CDM,310,RC,81254,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GJB6 GENE COM VARIANTS,30100531,CDM,310,RC,81254,HCPCS,facility,both,,,,325,325,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HFE GENE,30100532,CDM,310,RC,81256,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IKBKAP GENE,30100534,CDM,310,RC,81260,HCPCS,facility,both,,,,182.13,182.13,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGH GENE REARRANGE AMP METH,30100535,CDM,310,RC,81261,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGH VARI REGIONAL MUTATION,30100536,CDM,310,RC,81263,HCPCS,facility,both,,,,311.93,311.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (275),30100537,CDM,310,RC,81265,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPEC ANAL ADDL,30100538,CDM,310,RC,81266,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHIMERISM ANAL NO CELL SELEC,30100539,CDM,310,RC,81267,HCPCS,facility,both,,,,533.83,533.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHIMERISM ANAL W/CELL SELECT,30100540,CDM,310,RC,81268,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE,30100542,CDM,310,RC,81275,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LONG QT SYND GENE FULL SEQ,30100543,CDM,309,RC,81280,HCPCS,facility,both,,,,2438.6,2438.6,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LONG QT SYN GENE DUP/DLT VAR,30100544,CDM,309,RC,81282,HCPCS,facility,both,,,,1093.26,1093.26,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MGMT GENE METHYLATION ANAL,30100545,CDM,310,RC,81287,HCPCS,facility,both,,,,889.71,889.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MGMT GENE METHYLATION ANAL,30100545,CDM,310,RC,81287,HCPCS,facility,both,,,,695,695,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MCOLN1 GENE,30100546,CDM,310,RC,81290,HCPCS,facility,both,,,,154.91,154.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MLH1 GENE DUP/DELETE VARIANT,30100547,CDM,310,RC,81294,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MICROSATELLITE INSTABILITY,30100548,CDM,310,RC,81301,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MECP2 GENE FULL SEQ,30100549,CDM,310,RC,81302,HCPCS,facility,both,,,,1402.6,1402.6,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAL SERUM ACETONE/KETONES,30100552,CDM,301,RC,82009,HCPCS,facility,both,,,,15.5,15.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BILE ACIDS; TOTAL,30100555,CDM,301,RC,82239,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BILE ACIDS; TOTAL,30100555,CDM,301,RC,82239,HCPCS,facility,both,,,,197,197,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHEMILUMINESCENT ASSAY,30100558,CDM,301,RC,82397,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHEMILUMINESCENT ASSAY,30100558,CDM,301,RC,82397,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CPK: ISOENZYMES,30100560,CDM,301,RC,82552,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DESOXYCORTICOSTERONE 11,30100561,CDM,301,RC,82633,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ELECTROPHORESIS NES,30100562,CDM,301,RC,82664,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ELECTROPHORESIS NES,30100562,CDM,301,RC,82664,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ESTROGENS; TOTAL,30100563,CDM,301,RC,82672,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTROGENS; TOTAL,30100563,CDM,301,RC,82672,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD GAS PH ONLY,30100565,CDM,301,RC,82800,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD GAS PH ONLY,30100565,CDM,301,RC,82800,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL LUNG MATURITY; QUAN,30100569,CDM,301,RC,83661,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL LUNG MATURITY; QUAN,30100569,CDM,301,RC,83661,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEUCINE AMINOPEPTIDASE,30100570,CDM,301,RC,83670,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUCINE AMINOPEPTIDASE,30100570,CDM,301,RC,83670,HCPCS,facility,both,,,,32.75,32.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PCP QUAN ASSAY,30100573,CDM,301,RC,83992,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PCP QUAN ASSAY,30100573,CDM,301,RC,83992,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THYROID STIMULATING IMMUNOGLOBULINS,30100576,CDM,301,RC,84445,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THYROID STIMULATING IMMUNOGLOBULINS,30100576,CDM,301,RC,84445,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC URINE DRUG SCREEN (8TEST),30100579,CDM,301,RC,80301,HCPCS,facility,both,,,,87.68,87.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYP2C19 GENE COM VARIANTS,30100581,CDM,310,RC,81225,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC F2 GENE,30100582,CDM,310,RC,81240,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC F2 GENE,30100582,CDM,310,RC,81240,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC F5 GENE,30100583,CDM,310,RC,81241,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC F5 GENE,30100583,CDM,310,RC,81241,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MTHFR GENE,30100584,CDM,310,RC,81291,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MTHFR GENE,30100584,CDM,310,RC,81291,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40),30100585,CDM,301,RC,82104,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40),30100585,CDM,301,RC,82104,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMINO ACIDS; 2-5 QUAN EA,30100586,CDM,301,RC,82136,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMINO ACIDS; 2-5 QUAN EA,30100586,CDM,301,RC,82136,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC STONE; QUANTITATIVE ANALYSIS,  CHEMICAL",30100589,CDM,301,RC,82360,HCPCS,facility,both,,,,42.5,42.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHOLINESTERASE; SERUM,30100592,CDM,301,RC,82480,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIBUCAINE NUMBER,30100594,CDM,301,RC,82638,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCOSE; BLD BY MONITOR DEVICE,30100595,CDM,301,RC,82962,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCOSE; BLD BY MONITOR DEVICE,30100595,CDM,301,RC,82962,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC KETOSTEROIDS 17; FRACTIONATION,30100599,CDM,301,RC,83593,HCPCS,facility,both,,,,213.5,213.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC KETOSTEROIDS 17; FRACTIONATION,30100599,CDM,301,RC,83593,HCPCS,facility,both,,,,43.96,43.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LIPOPRO BLD ELECTROPHORETIC,30100600,CDM,301,RC,83700,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SUGARS; MULTI QUAL EA SPECIMEN,30100603,CDM,301,RC,84377,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KETOSTEROIDS 17; TOTAL,30100607,CDM,301,RC,83586,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTIEPILEPTICS, NOS 1-3",30100610,CDM,301,RC,80339,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTIEPILEPTICS, NOS 1-3",30100610,CDM,301,RC,80339,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ONCOPROTEIN DCP,30100612,CDM,301,RC,83951,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOTAL ACID PHOSPHATASE,30100613,CDM,301,RC,84060,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOTAL ACID PHOSPHATASE,30100613,CDM,301,RC,84060,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREGNANETRIOL,30100618,CDM,301,RC,84138,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREGNANETRIOL,30100618,CDM,301,RC,84138,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROCALCITONIN (PCT),30100619,CDM,301,RC,84145,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROCALCITONIN (PCT),30100619,CDM,301,RC,84145,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROSTAGLANDIN EACH,30100620,CDM,301,RC,84150,HCPCS,facility,both,,,,81.64,81.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROSTAGLANDIN EACH,30100620,CDM,301,RC,84150,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SUGARS; SINGLE QUAL EA SPECIMEN,30100624,CDM,301,RC,84376,HCPCS,facility,both,,,,26.4,26.4,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SUGARS; SINGLE QUAL EA SPECIMEN,30100624,CDM,301,RC,84376,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRYPSIN; DUODENAL FLUID,30100627,CDM,301,RC,84485,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYCLIC ADP OR AMP,30100634,CDM,301,RC,82030,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYCLIC ADP OR AMP,30100634,CDM,301,RC,82030,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANDROSTANEDIOL GLUCURONIDE,30100635,CDM,301,RC,82154,HCPCS,facility,both,,,,62.5,62.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANDROSTANEDIOL GLUCURONIDE,30100635,CDM,301,RC,82154,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CPK; ISOFORMS,30100640,CDM,301,RC,82554,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CPK; ISOFORMS,30100640,CDM,301,RC,82554,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIHYDROCODEINONE QUAN,30100641,CDM,301,RC,82646,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NPM1 GENE,30100653,CDM,310,RC,81310,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PML/RARALPHA COM BREAKPOINTS,30100654,CDM,310,RC,81315,HCPCS,facility,both,,,,230.28,230.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PTEN GENE FULL SEQUENCE,30100655,CDM,310,RC,81321,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PTEN GENE FULL SEQUENCE,30100655,CDM,310,RC,81321,HCPCS,facility,both,,,,2271.38,2271.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PTEN GENE DUP/DELET VARIANT,30100657,CDM,310,RC,81323,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMP22 GENE DUP/DELET,30100658,CDM,310,RC,81324,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMP22 GENE FULL SEQUENCE,30100659,CDM,310,RC,81325,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMP22 GENE KNOWN FAM VARIANT,30100660,CDM,310,RC,81326,HCPCS,facility,both,,,,740,740,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PMP22 GENE KNOWN FAM VARIANT,30100660,CDM,310,RC,81326,HCPCS,facility,both,,,,879.25,879.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMPD1 GENE COMMON VARIANTS,30100661,CDM,310,RC,81330,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMPD1 GENE COMMON VARIANTS,30100661,CDM,310,RC,81330,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SNRPN/UBE3A GENE,30100662,CDM,310,RC,81331,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERPINA1 GENE,30100663,CDM,310,RC,81332,HCPCS,facility,both,,,,87.93,87.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRG GENE REARRANGEMENT ANAL,30100664,CDM,310,RC,81342,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VKORC1 GENE,30100665,CDM,310,RC,81355,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I TYPING COMPLETE LR (150),30100666,CDM,310,RC,81372,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I TYPING 1 ANTIGEN LR (150),30100667,CDM,310,RC,81374,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA II TYPING AG EQUIV LR (170),30100668,CDM,310,RC,81375,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA II TYPING 1 LOCUS LR (40),30100669,CDM,310,RC,81376,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA II TYPING 1 LOCUS LR (40),30100669,CDM,310,RC,81376,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HLA I TYPING COMPLETE HR (290),30100670,CDM,310,RC,81379,HCPCS,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I TYPING 1 ALLELE HR,30100671,CDM,310,RC,81381,HCPCS,facility,both,,,,151,151,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HLA I TYPING 1 ALLELE HR,30100671,CDM,310,RC,81381,HCPCS,facility,both,,,,177.94,177.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  HLA II TYPING 1 LOCUS HR (40),30100672,CDM,310,RC,81382,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  HLA II TYPING 1 LOCUS HR (40),30100672,CDM,310,RC,81382,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 1,30100674,CDM,310,RC,81400,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 2,30100675,CDM,310,RC,81401,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 2,30100675,CDM,310,RC,81401,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 3,30100676,CDM,310,RC,81402,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 4,30100677,CDM,310,RC,81403,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 4,30100677,CDM,310,RC,81403,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 5,30100678,CDM,310,RC,81404,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 5,30100678,CDM,310,RC,81404,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 6,30100679,CDM,310,RC,81405,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 6,30100679,CDM,310,RC,81405,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 7,30100680,CDM,310,RC,81406,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7,30100680,CDM,310,RC,81406,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 8,30100681,CDM,310,RC,81407,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 8,30100681,CDM,310,RC,81407,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 9,30100682,CDM,310,RC,81408,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 9,30100682,CDM,310,RC,81408,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLECULAR PATHOLOGY,30100683,CDM,310,RC,81479,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLECULAR PATHOLOGY,30100683,CDM,310,RC,81479,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DISOPYRAMIDE,30100684,CDM,301,RC,80299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DISOPYRAMIDE,30100684,CDM,301,RC,80299,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LORAZEPAM,30100685,CDM,301,RC,80299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOMIPRAMINE,30100686,CDM,301,RC,80299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLUOXETIN,30100687,CDM,301,RC,80332,HCPCS,facility,both,,,,36.75,36.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLUOXETIN,30100687,CDM,301,RC,80332,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMIODARONE,30100688,CDM,301,RC,80299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN SINGLE X 9,30100689,CDM,301,RC,80301,HCPCS,facility,both,,,,98.64,98.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN SINGLE,30100690,CDM,301,RC,80301,HCPCS,facility,both,,,,10.96,10.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VALPROIC ACID FREE,30100692,CDM,301,RC,80165,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VALPROIC ACID FREE,30100692,CDM,301,RC,80165,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALCOHOL,30100693,CDM,301,RC,80320,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALCOHOL,30100693,CDM,301,RC,80320,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ALCOHOL,30100693,CDM,301,RC,80320,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANTIDEPRESSANT 1 OR 2,30100694,CDM,301,RC,80335,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTIDEPRESSANT 1 OR 2,30100694,CDM,301,RC,80335,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROPOXYPHENE,30100695,CDM,301,RC,80367,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROPOXYPHENE,30100695,CDM,301,RC,80367,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BUPRENORPHINE,30100696,CDM,301,RC,80348,HCPCS,facility,both,,,,68.45,68.45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BUPRENORPHINE,30100696,CDM,301,RC,80348,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  ALKALOIDS NOS,30100697,CDM,301,RC,80323,HCPCS,facility,both,,,,77.46,77.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC METHADONE,30100698,CDM,301,RC,80358,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANABOLIC STEROIDS, 1 OR 2",30100699,CDM,301,RC,80327,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANALGESICS,NON-OPIOD 1 OR 2",30100700,CDM,301,RC,80329,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG CLASS A SCREEN IEA;5 DRUG,30100701,CDM,301,RC,80301,HCPCS,facility,both,,,,54.8,54.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC  CANNABINOIDS,NATURAL",30100702,CDM,301,RC,80349,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC  CANNABINOIDS,NATURAL",30100702,CDM,301,RC,80349,HCPCS,facility,both,,,,74.5,74.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREGABALIN,30100703,CDM,301,RC,80366,HCPCS,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREGABALIN,30100703,CDM,301,RC,80366,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG CLASS A SCREEN IEA; 7 DRUG,30100704,CDM,301,RC,80301,HCPCS,facility,both,,,,76.72,76.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN AMPHETAMINES 1 OR 2,30100706,CDM,301,RC,80324,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREEN AMPHETAMINES 1 OR 2,30100706,CDM,301,RC,80324,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPLEMENT C3A,30100707,CDM,301,RC,83520,HCPCS,facility,both,,,,143,143,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (25),30100709,CDM,301,RC,80299,HCPCS,facility,both,,,,40.25,40.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (25),30100709,CDM,301,RC,80299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (30),30100710,CDM,301,RC,80299,HCPCS,facility,both,,,,44.75,44.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (30),30100710,CDM,301,RC,80299,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (30),30100710,CDM,301,RC,80299,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (35),30100711,CDM,301,RC,80299,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (35),30100711,CDM,301,RC,80299,HCPCS,facility,both,,,,71.35,71.35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (55),30100712,CDM,301,RC,80299,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (55),30100712,CDM,301,RC,80299,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (65),30100713,CDM,301,RC,80299,HCPCS,facility,both,,,,136.07,136.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (65),30100713,CDM,301,RC,80299,HCPCS,facility,both,,,,107,107,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (75),30100714,CDM,301,RC,80299,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (75),30100714,CDM,301,RC,80299,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (80),30100715,CDM,301,RC,80299,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (80),30100715,CDM,301,RC,80299,HCPCS,facility,both,,,,167.48,167.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (145),30100716,CDM,301,RC,80299,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (145),30100716,CDM,301,RC,80299,HCPCS,facility,both,,,,303.55,303.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (165),30100717,CDM,301,RC,80299,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (165),30100717,CDM,301,RC,80299,HCPCS,facility,both,,,,257,257,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC DRUG CLASS A SCRN BY IA, 9",30100718,CDM,301,RC,80301,HCPCS,facility,both,,,,98.64,98.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING COCAINE,30100719,CDM,301,RC,80353,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING COCAINE,30100719,CDM,301,RC,80353,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OPIOID &OPIATE ANALOG 5/MORE,30100720,CDM,301,RC,80364,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OPIOID &OPIATE ANALOG 5/MORE,30100720,CDM,301,RC,80364,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (85),30100721,CDM,301,RC,80299,HCPCS,facility,both,,,,156.25,156.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (85),30100721,CDM,301,RC,80299,HCPCS,facility,both,,,,177.94,177.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  UNLISTED CHEM PROC (200),30100722,CDM,301,RC,84999,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  UNLISTED CHEM PROC (200),30100722,CDM,301,RC,84999,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED CHEM PROC (25),30100723,CDM,301,RC,84999,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED CHEM PROC (25),30100723,CDM,301,RC,84999,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY C-D TGREANSFER MEASURE (155),30100724,CDM,301,RC,82373,HCPCS,facility,both,,,,324.48,324.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY C-D TGREANSFER MEASURE (155),30100724,CDM,301,RC,82373,HCPCS,facility,both,,,,225,225,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-DEPRESS,SEROTO 1-2 (45)",30100725,CDM,301,RC,80332,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-DEPRESS,SEROTO 1-2 (45)",30100725,CDM,301,RC,80332,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-DEPRESS,SEROTO 1-2 (50)",30100726,CDM,301,RC,80332,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-DEPRESS,SEROTO 1-2 (50)",30100726,CDM,301,RC,80332,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-DEPRESS,SEROTO 1-2 (70)",30100727,CDM,301,RC,80332,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-DEPRESS,SEROTO 1-2 (70)",30100727,CDM,301,RC,80332,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (40)",30100728,CDM,301,RC,80342,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (40)",30100728,CDM,301,RC,80342,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-PSYCHOTIC ,NOS 1-3 (45)",30100729,CDM,301,RC,80342,HCPCS,facility,both,,,,93,93,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-PSYCHOTIC ,NOS 1-3 (45)",30100729,CDM,301,RC,80342,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (50)",30100730,CDM,301,RC,80342,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-PSYCHOTIC ,NOS 1-3 (50)",30100730,CDM,301,RC,80342,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (70)",30100731,CDM,301,RC,80342,HCPCS,facility,both,,,,133,133,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-PSYCHOTIC ,NOS 1-3 (70)",30100731,CDM,301,RC,80342,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (105)",30100732,CDM,301,RC,80342,HCPCS,facility,both,,,,219.81,219.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (105)",30100732,CDM,301,RC,80342,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-PSYCHOTIC ,NOS 1-3 (110)",30100733,CDM,301,RC,80342,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-PSYCHOTIC ,NOS 1-3 (110)",30100733,CDM,301,RC,80342,HCPCS,facility,both,,,,230.28,230.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (115)",30100734,CDM,301,RC,80342,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTI-PSYCHOTIC ,NOS 1-3 (115)",30100734,CDM,301,RC,80342,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-DEPRESS, NOS (60)",30100735,CDM,301,RC,80338,HCPCS,facility,both,,,,115,115,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC ANTI-DEPRESS, NOS (60)",30100735,CDM,301,RC,80338,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (95)",30100736,CDM,301,RC,80375,HCPCS,facility,both,,,,198.87,198.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (95)",30100736,CDM,301,RC,80375,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC  CHLORINATED HYDROCARBONS, SCRN",30100737,CDM,301,RC,82441,HCPCS,facility,both,,,,35.59,35.59,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG/SUBST DEFINITIVE QUAL/QUANT,30100738,CDM,301,RC,80375,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG SCRN,NOS PRESUMPTIVE",30100739,CDM,301,RC,80304,HCPCS,facility,both,,,,41.1,41.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCRN OXYCODONE,30100740,CDM,301,RC,80365,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCRN OXYCODONE,30100740,CDM,301,RC,80365,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PAPPA SERUM,30100741,CDM,301,RC,84163,HCPCS,facility,both,,,,43.96,43.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HCG FREE BETA CHAIN,30100742,CDM,301,RC,84704,HCPCS,facility,both,,,,43.96,43.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNSP CHEM PROC (280),30100743,CDM,301,RC,84999,HCPCS,facility,both,,,,586.16,586.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANT ASSAY DRUG (250),30100744,CDM,301,RC,80299,HCPCS,facility,both,,,,523.36,523.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUANTITATIVE ASSAY DRUG (40),30100745,CDM,301,RC,80299,HCPCS,facility,both,,,,82.8,82.8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANTITATIVE ASSAY DRUG (40),30100745,CDM,301,RC,80299,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (10),30100746,CDM,301,RC,83520,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (10),30100746,CDM,301,RC,83520,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARB DEFICIENT TRANSFERRIN (30),30100747,CDM,301,RC,82373,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARB DEFICIENT TRANSFERRIN (30),30100747,CDM,301,RC,82373,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC  DRUG SCREEN, INSTRUMENT SINGLE DRUG",30100748,CDM,301,RC,80307,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC  DRUG SCREEN, INSTRUMENT SINGLE DRUG",30100748,CDM,301,RC,80307,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG",30100749,CDM,301,RC,80307,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG",30100749,CDM,301,RC,80307,HCPCS,facility,both,,,,133.98,133.98,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG",30100749,CDM,301,RC,80307,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC DRUG SCREEN, INSTRUMENT 9 DRUG",30100750,CDM,301,RC,80307,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC DRUG SCREEN, INSTRUMENT 9 DRUG",30100750,CDM,301,RC,80307,HCPCS,facility,both,,,,150.73,150.73,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG SCREEN, INSTRUMENT 12 DRUG",30100751,CDM,301,RC,80307,HCPCS,facility,both,,,,200.97,200.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG SCREEN, INSTRUMENT 12 DRUG",30100751,CDM,301,RC,80307,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
"HC DRUG SCREEN, INSTRUMENT 12 DRUG",30100751,CDM,301,RC,80307,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC DRUG SCREEN, INSTRUMENT 5 DRUG",30100752,CDM,301,RC,80307,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG SCREEN, INSTRUMENT 5 DRUG",30100752,CDM,301,RC,80307,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREEN  MASS SPEC INSTR,30100753,CDM,301,RC,80307,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREEN  MASS SPEC INSTR,30100753,CDM,301,RC,80307,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (270),30100754,CDM,301,RC,83520,HCPCS,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALCOHOLS BIOMARKERS 1 OR 2,30100755,CDM,301,RC,80321,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALCOHOLS BIOMARKERS 1 OR 2,30100755,CDM,301,RC,80321,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALCOHOLS BIOMARKERS 1 OR 2,30100755,CDM,301,RC,80321,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC IMMUNOASSAY QUANT NOS NONAB (135),30100756,CDM,301,RC,83520,HCPCS,facility,both,,,,235,235,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNOASSAY QUANT NOS NONAB (135),30100756,CDM,301,RC,83520,HCPCS,facility,both,,,,282.61,282.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (50),30100757,CDM,301,RC,83520,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (50),30100757,CDM,301,RC,83520,HCPCS,facility,both,,,,104.49,104.49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUANT ASSAY DRUG (265),30100758,CDM,301,RC,80299,HCPCS,facility,both,,,,554.76,554.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY LIPOPROTEIN PLA2 (35),30100759,CDM,301,RC,83698,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY LIPOPROTEIN PLA2 (35),30100759,CDM,301,RC,83698,HCPCS,facility,both,,,,65.45,65.45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUMOASSAY QUANT NOS NONAB (345),30100760,CDM,301,RC,83520,HCPCS,facility,both,,,,722.23,722.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG/SUBSTANCE NOS 7/MORE (40),30100761,CDM,301,RC,80377,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG/SUBSTANCE NOS 7/MORE (40),30100761,CDM,301,RC,80377,HCPCS,facility,both,,,,71.91,71.91,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG/SUBSTANCE NOS 7/MORE (30),30100762,CDM,301,RC,80377,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG/SUBSTANCE NOS 7/MORE (30),30100762,CDM,301,RC,80377,HCPCS,facility,both,,,,51.51,51.51,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG/SUBSTANCE NOS 7/MORE (30),30100762,CDM,301,RC,80377,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC DRUG/SUBSTANCE NOS 7/MORE (135),30100763,CDM,301,RC,80377,HCPCS,facility,both,,,,282.61,282.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG/SUBSTANCE NOS 7/MORE (135),30100763,CDM,301,RC,80377,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEROIN METABOLITE (25),30100764,CDM,301,RC,80356,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEROIN METABOLITE (25),30100764,CDM,301,RC,80356,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KETAMINE AND NORKETAMINE (25),30100765,CDM,301,RC,80357,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC KETAMINE AND NORKETAMINE (25),30100765,CDM,301,RC,80357,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OPIOIDS AND OPIATE ANALOGS 1/2 (30),30100766,CDM,301,RC,80362,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OPIOIDS AND OPIATE ANALOGS 1/2 (30),30100766,CDM,301,RC,80362,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TRAMADOL (30),30100767,CDM,301,RC,80373,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRAMADOL (30),30100767,CDM,301,RC,80373,HCPCS,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CALC GENE COM VARIANTS (210),30100768,CDM,310,RC,81219,HCPCS,facility,both,,,,398,398,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CALC GENE COM VARIANTS (210),30100768,CDM,310,RC,81219,HCPCS,facility,both,,,,439.62,439.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC GLUCOSIDASE, BETA",30100769,CDM,301,RC,82963,HCPCS,facility,both,,,,63.5,63.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC GLUCOSIDASE, BETA",30100769,CDM,301,RC,82963,HCPCS,facility,both,,,,81.64,81.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUMOASSAY QUANT NOS NONAB (205),30100770,CDM,301,RC,83520,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIHYDROTESTOSTERONE (DHT),30100771,CDM,301,RC,82642,HCPCS,facility,both,,,,56.5,56.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DIHYDROTESTOSTERONE (DHT),30100771,CDM,301,RC,82642,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (354),30100772,CDM,301,RC,83520,HCPCS,facility,both,,,,741.08,741.08,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (354),30100772,CDM,301,RC,83520,HCPCS,facility,both,,,,656,656,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC METHYLENEDIOXYAMPHETAMINES (29),30100773,CDM,301,RC,80359,HCPCS,facility,both,,,,60.71,60.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC METHYLENEDIOXYAMPHETAMINES (29),30100773,CDM,301,RC,80359,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC  CANNABINOIDS,NATURAL (19)",30100774,CDM,301,RC,80349,HCPCS,facility,both,,,,39.77,39.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC BENZODIAZEPINES, 1-12 (19)",30100775,CDM,301,RC,80346,HCPCS,facility,both,,,,39.77,39.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BARBITURATES (9),30100776,CDM,301,RC,80345,HCPCS,facility,both,,,,18.84,18.84,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING COCAINE (6),30100777,CDM,301,RC,80353,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OPIATES 1 OR MORE (7),30100778,CDM,301,RC,80361,HCPCS,facility,both,,,,14.65,14.65,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCRN OXYCODONE (7),30100779,CDM,301,RC,80365,HCPCS,facility,both,,,,14.65,14.65,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC METHADONE (22),30100780,CDM,301,RC,80358,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC METHADONE (22),30100780,CDM,301,RC,80358,HCPCS,facility,both,,,,46.06,46.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING COCAINE (39),30100781,CDM,301,RC,80353,HCPCS,facility,both,,,,81.64,81.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING COCAINE (39),30100781,CDM,301,RC,80353,HCPCS,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREENING OXYCODONE (14),30100782,CDM,301,RC,80365,HCPCS,facility,both,,,,21.5,21.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREENING OXYCODONE (14),30100782,CDM,301,RC,80365,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING BUPRENORPHINE (39),30100783,CDM,301,RC,80348,HCPCS,facility,both,,,,81.64,81.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING BUPRENORPHINE (39),30100783,CDM,301,RC,80348,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG TEST PRSMV CHEM ANLYZR (19),30100784,CDM,301,RC,80307,HCPCS,facility,both,,,,39.77,39.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY ADALIMUMAB (265),30100785,CDM,301,RC,80145,HCPCS,facility,both,,,,290,290,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG ASSAY ADALIMUMAB (265),30100785,CDM,301,RC,80145,HCPCS,facility,both,,,,554.76,554.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY POSACONAZOLE (30),30100786,CDM,301,RC,80187,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG ASSAY POSACONAZOLE (30),30100786,CDM,301,RC,80187,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY INFLIXIMAB (165),30100787,CDM,301,RC,80230,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY INFLIXIMAB (165),30100787,CDM,301,RC,80230,HCPCS,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG ASSAY LACOSAMIDE (80),30100788,CDM,301,RC,80235,HCPCS,facility,both,,,,167,167,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG ASSAY LACOSAMIDE (80),30100788,CDM,301,RC,80235,HCPCS,facility,both,,,,167.48,167.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY VORICONAZOLE (45),30100789,CDM,301,RC,80285,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NFCT DS CHRNC HCV 6 ASSAYS (55),30100790,CDM,310,RC,81596,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NFCT DS CHRNC HCV 6 ASSAYS (55),30100790,CDM,310,RC,81596,HCPCS,facility,both,,,,308.75,308.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALCOHOLS BIOMARKERS 1 OR 2 (63),30100791,CDM,301,RC,80321,HCPCS,facility,both,,,,131.89,131.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED CHEM PROC (1),30100792,CDM,301,RC,84999,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG SCREENING FENTANYL (38),30100793,CDM,301,RC,80354,HCPCS,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DRUG SCREENING FENTANYL (38),30100793,CDM,301,RC,80354,HCPCS,facility,both,,,,79.55,79.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACETOMINOPHEN,30100795,CDM,301,RC,80143,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ACETOMINOPHEN,30100795,CDM,301,RC,80143,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMIODARONE,30100796,CDM,301,RC,80151,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMIODARONE,30100796,CDM,301,RC,80151,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC CARBAMAZEPINE;10,11-EPOXIDE",30100797,CDM,301,RC,80161,HCPCS,facility,both,,,,81.5,81.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC CARBAMAZEPINE;10,11-EPOXIDE",30100797,CDM,301,RC,80161,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FELBAMATE,30100798,CDM,301,RC,80167,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FELBAMATE,30100798,CDM,301,RC,80167,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SALICYLATE,30100799,CDM,301,RC,80179,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SALICYLATE,30100799,CDM,301,RC,80179,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLECAINIDE,30100800,CDM,301,RC,80181,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLECAINIDE,30100800,CDM,301,RC,80181,HCPCS,facility,both,,,,82.5,82.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ITRACONAZOLE,30100801,CDM,301,RC,80189,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ITRACONAZOLE,30100801,CDM,301,RC,80189,HCPCS,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEFLUNOMIDE,30100802,CDM,301,RC,80193,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEFLUNOMIDE,30100802,CDM,301,RC,80193,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC METHOTREXATE,30100803,CDM,301,RC,80204,HCPCS,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC METHOTREXATE,30100803,CDM,301,RC,80204,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RUFINAMIDE,30100804,CDM,301,RC,80210,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RUFINAMIDE,30100804,CDM,301,RC,80210,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY SPEC XCP UR&BREATH IA,30100805,CDM,301,RC,82077,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY SPEC XCP UR&BREATH IA,30100805,CDM,301,RC,82077,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY DIR MEAS FR ESTRADIOL,30100806,CDM,301,RC,82681,HCPCS,facility,both,,,,205,205,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY DIR MEAS FR ESTRADIOL,30100806,CDM,301,RC,82681,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY HYDROXYCHLOROQUINE,30100811,CDM,301,RC,80220,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EL-1 FECAL QUANTITATIVE,30100812,CDM,301,RC,82653,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IG LIGHT CHAINS FREE EACH,30100813,CDM,301,RC,83521,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY OF INTERLEUKIN-6 (IL-6),30100814,CDM,301,RC,83529,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DRUG ASSAY ADALIMUMAB,30100817,CDM,301,RC,80145,HCPCS,facility,both,,,,301.45,301.45,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC SYNTHETIC GLUCOCORTICOID SCREEN, SERUM(91)",30100820,CDM,301,RC,80299,HCPCS,facility,both,,,,190.51,190.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTI-MULLERIAN HORMONE (AMH),30100823,CDM,301,RC,82166,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ENZYME EVAL; ALPHA GALA, EACH SPECIMEN",30100831,CDM,301,RC,82657,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC- DRUG SCREEN, INSTRUMENT 13  DRUG",30100832,CDM,301,RC,80307,HCPCS,facility,both,,,,217.71,217.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INTERLEUKIN-18 (282),30100833,CDM,301,RC,83520,HCPCS,facility,both,,,,590.35,590.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (44)",30100835,CDM,301,RC,80375,HCPCS,facility,both,,,,92.11,92.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (109),30100836,CDM,301,RC,83520,HCPCS,facility,both,,,,228.19,228.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC TAU, TOTAL (109)",30100837,CDM,301,RC,84394,HCPCS,facility,both,,,,228.19,228.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NEUROFILAMENT LT CHN (40),30100838,CDM,301,RC,83884,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (177),30100840,CDM,301,RC,83520,HCPCS,facility,both,,,,370.71,370.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (127),30100841,CDM,301,RC,83520,HCPCS,facility,both,,,,265.99,265.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNOASSAY QUANT NOS NONAB (30),30100842,CDM,301,RC,83520,HCPCS,facility,both,,,,62.83,62.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC TAU PHOSPHORYLATED, EACH (154)",30100865,CDM,301,RC,84393,HCPCS,facility,both,,,,321.86,321.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BETA-AMYLOID; 1-42 (ABETA) (154),30100866,CDM,301,RC,82234,HCPCS,facility,both,,,,321.86,321.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC TAU, TOTAL (154)",30100867,CDM,301,RC,84394,HCPCS,facility,both,,,,321.86,321.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INHIBIN-B       QUEST,30160029,CDM,301,RC,83520,HCPCS,facility,both,,,,92.11,92.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SOLUBLE LIVER ANTIGEN   QUEST,30160037,CDM,301,RC,83520,HCPCS,facility,both,,,,27.22,27.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CBG(CORTICOSTER BIND GLOB) NIC,30160071,CDM,301,RC,84449,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC TYROSINE,FILTER CARD",30160073,CDM,301,RC,84510,HCPCS,facility,both,,,,33.49,33.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LAB IMMUNOLOGY,30200000,CDM,302,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACUTE HEPATITIS PANEL,30200001,CDM,301,RC,80074,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ACUTE HEPATITIS PANEL,30200001,CDM,301,RC,80074,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ETHOSUXIMIDE,30200003,CDM,301,RC,80168,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ETHOSUXIMIDE,30200003,CDM,301,RC,80168,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALDOLASE,30200004,CDM,301,RC,82085,HCPCS,facility,both,,,,23.8,23.8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALDOLASE,30200004,CDM,301,RC,82085,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALPHA-1-ANTITRYPSIN; TOTAL,30200005,CDM,301,RC,82103,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ALPHA-1-ANTITRYPSIN; TOTAL,30200005,CDM,301,RC,82103,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALPHA-1-ANTITRYPSIN; TOTAL,30200005,CDM,301,RC,82103,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALUMINUM ASSAY,30200006,CDM,301,RC,82108,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALUMINUM ASSAY,30200006,CDM,301,RC,82108,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMINO ACIDS; SGL QUAN EA,30200007,CDM,301,RC,82131,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMINO ACIDS; SGL QUAN EA,30200007,CDM,301,RC,82131,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DELTA ALA,30200008,CDM,301,RC,82135,HCPCS,facility,both,,,,54.43,54.43,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DELTA ALA,30200008,CDM,301,RC,82135,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANDROSTENEDIONE,30200009,CDM,301,RC,82157,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANDROSTENEDIONE,30200009,CDM,301,RC,82157,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANGIOTENSIN II,30200010,CDM,301,RC,82163,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANGIOTENSIN II,30200010,CDM,301,RC,82163,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANGIOTENSIN I - CONVERTING ENZYME,30200011,CDM,301,RC,82164,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANGIOTENSIN I - CONVERTING ENZYME,30200011,CDM,301,RC,82164,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC APOLIPOPROTEIN EACH,30200012,CDM,301,RC,82172,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC APOLIPOPROTEIN EACH,30200012,CDM,301,RC,82172,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC APOLIPOPROTEIN EACH,30200012,CDM,301,RC,82172,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ARSENIC,30200013,CDM,301,RC,82175,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ARSENIC,30200013,CDM,301,RC,82175,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BIOTINIDASE EA SPECIMEN,30200014,CDM,301,RC,82261,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BIOTINIDASE EA SPECIMEN,30200014,CDM,301,RC,82261,HCPCS,facility,both,,,,115,115,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARB DEFICIENT TRANSRERRIN,30200015,CDM,301,RC,82373,HCPCS,facility,both,,,,68.25,68.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CAROTENE,30200016,CDM,301,RC,82380,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CAROTENE,30200016,CDM,301,RC,82380,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CATECHOLAMINES FRACTIONATED,30200017,CDM,301,RC,82384,HCPCS,facility,both,,,,47.75,47.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CATECHOLAMINES FRACTIONATED,30200017,CDM,301,RC,82384,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CERULOPLASMIN,30200018,CDM,301,RC,82390,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CERULOPLASMIN,30200018,CDM,301,RC,82390,HCPCS,facility,both,,,,25.6,25.6,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CITRATE,30200019,CDM,301,RC,82507,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CITRATE,30200019,CDM,301,RC,82507,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYANIDE,30200020,CDM,301,RC,82600,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYANIDE,30200020,CDM,301,RC,82600,HCPCS,facility,both,,,,60.71,60.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VIT  B-12; UNSATURATED BC,30200021,CDM,301,RC,82608,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIT  B-12; UNSATURATED BC,30200021,CDM,301,RC,82608,HCPCS,facility,both,,,,48.15,48.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DHEA,30200022,CDM,301,RC,82626,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DHEA,30200022,CDM,301,RC,82626,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DHEA-S,30200023,CDM,301,RC,82627,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC DHEA-S,30200023,CDM,301,RC,82627,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DHEA-S,30200023,CDM,301,RC,82627,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DEOXYCORTISOL 11,30200024,CDM,301,RC,82634,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DEOXYCORTISOL 11,30200024,CDM,301,RC,82634,HCPCS,facility,both,,,,65.5,65.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ERYTHROPOIETIN,30200026,CDM,301,RC,82668,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ERYTHROPOIETIN,30200026,CDM,301,RC,82668,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTROGENS; FRACTIONATED,30200027,CDM,301,RC,82671,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTROGENS; FRACTIONATED,30200027,CDM,301,RC,82671,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ESTRONE,30200028,CDM,301,RC,82679,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ESTRONE,30200028,CDM,301,RC,82679,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ETHYLENE GLYCOL,30200029,CDM,301,RC,82693,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ETHYLENE GLYCOL,30200029,CDM,301,RC,82693,HCPCS,facility,both,,,,44.5,44.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FAT/LIPIDS FECES; QUAL,30200030,CDM,301,RC,82705,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FAT/LIPIDS FECES; QUAL,30200030,CDM,301,RC,82705,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FATTY ACIDS NONESTERIFIED,30200031,CDM,301,RC,82725,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FATTY ACIDS NONESTERIFIED,30200031,CDM,301,RC,82725,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GALACTOKINASE RBC,30200032,CDM,301,RC,82759,HCPCS,facility,both,,,,71.17,71.17,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GALACTOKINASE RBC,30200032,CDM,301,RC,82759,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GALACTOSEMIA; QUAN,30200033,CDM,301,RC,82775,HCPCS,facility,both,,,,175,175,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GALACTOSEMIA; QUAN,30200033,CDM,301,RC,82775,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GASTRIN,30200034,CDM,301,RC,82941,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GASTRIN,30200034,CDM,301,RC,82941,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCAGON,30200035,CDM,301,RC,82943,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLUCAGON,30200035,CDM,301,RC,82943,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC G6PD; QUAN,30200036,CDM,301,RC,82955,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC G6PD; QUAN,30200036,CDM,301,RC,82955,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GLYCATED PROTEIN,30200037,CDM,301,RC,82985,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GLYCATED PROTEIN,30200037,CDM,301,RC,82985,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HISTAMINE,30200038,CDM,301,RC,83088,HCPCS,facility,both,,,,48.25,48.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HISTAMINE,30200038,CDM,301,RC,83088,HCPCS,facility,both,,,,50.25,50.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HOMOVANILLIC ACID,30200039,CDM,301,RC,83150,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HOMOVANILLIC ACID,30200039,CDM,301,RC,83150,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC 17-OHCS,30200040,CDM,301,RC,83491,HCPCS,facility,both,,,,33.5,33.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC 17-OHCS,30200040,CDM,301,RC,83491,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HYDROXYPROGESTERONE 17-D,30200041,CDM,301,RC,83498,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HYDROXYPROGESTERONE 17-D,30200041,CDM,301,RC,83498,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LDH; ISOENZYMES,30200042,CDM,301,RC,83625,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LDH; ISOENZYMES,30200042,CDM,301,RC,83625,HCPCS,facility,both,,,,39.75,39.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MANGANESE,30200043,CDM,301,RC,83785,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MANGANESE,30200043,CDM,301,RC,83785,HCPCS,facility,both,,,,79.5,79.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MERCURY QUAN,30200044,CDM,301,RC,83825,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MERCURY QUAN,30200044,CDM,301,RC,83825,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MYELIN BASIC PROTEIN CSF,30200046,CDM,301,RC,83873,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYELIN BASIC PROTEIN CSF,30200046,CDM,301,RC,83873,HCPCS,facility,both,,,,46.5,46.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NEPHELOMETRY EA ANALYTE NES,30200047,CDM,301,RC,83883,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NEPHELOMETRY EA ANALYTE NES,30200047,CDM,301,RC,83883,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OSTEOCALCIN,30200049,CDM,301,RC,83937,HCPCS,facility,both,,,,63,63,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OSTEOCALCIN,30200049,CDM,301,RC,83937,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC OSTEOCALCIN,30200049,CDM,301,RC,83937,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OXALATE,30200050,CDM,301,RC,83945,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OXALATE,30200050,CDM,301,RC,83945,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALKALINE PHOSPHATASE ISOENZYM,30200051,CDM,301,RC,84080,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALKALINE PHOSPHATASE ISOENZYM,30200051,CDM,301,RC,84080,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PORPHOBILINOGEN URINE; QUAN,30200052,CDM,301,RC,84110,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PORPHOBILINOGEN URINE; QUAN,30200052,CDM,301,RC,84110,HCPCS,facility,both,,,,27.22,27.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAN URINE PORPHYRINS,30200053,CDM,301,RC,84120,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAN URINE PORPHYRINS,30200053,CDM,301,RC,84120,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREGNENOLONE,30200054,CDM,301,RC,84140,HCPCS,facility,both,,,,42.75,42.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PREGNENOLONE,30200054,CDM,301,RC,84140,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC 17-HYDROXYPREGNENOLONE,30200055,CDM,301,RC,84143,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC 17-HYDROXYPREGNENOLONE,30200055,CDM,301,RC,84143,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTOPORPHYRIN RBC; QUAN,30200056,CDM,301,RC,84202,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTOPORPHYRIN RBC; QUAN,30200056,CDM,301,RC,84202,HCPCS,facility,both,,,,113.04,113.04,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROINSULIN,30200057,CDM,301,RC,84206,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROINSULIN,30200057,CDM,301,RC,84206,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VITAMIN B6,30200058,CDM,301,RC,84207,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN B6,30200058,CDM,301,RC,84207,HCPCS,facility,both,,,,58.25,58.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PYRUVATE,30200059,CDM,301,RC,84210,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PYRUVATE,30200059,CDM,301,RC,84210,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY NONENDOCRINE RECEPTOR,30200060,CDM,301,RC,84238,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY NONENDOCRINE RECEPTOR,30200060,CDM,301,RC,84238,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SEROTONIN,30200061,CDM,301,RC,84260,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SEROTONIN,30200061,CDM,301,RC,84260,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SEX HORMONE BINDING GLOBULIN,30200062,CDM,301,RC,84270,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SEX HORMONE BINDING GLOBULIN,30200062,CDM,301,RC,84270,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF THIAMINE (VITAMIN B-1),30200063,CDM,301,RC,84425,HCPCS,facility,both,,,,42.75,42.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY OF THIAMINE (VITAMIN B-1),30200063,CDM,301,RC,84425,HCPCS,facility,both,,,,102.58,102.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOCOPHEROL ALPHA (VIT E),30200064,CDM,301,RC,84446,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TOCOPHEROL ALPHA (VIT E),30200064,CDM,301,RC,84446,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T3; FREE,30200065,CDM,301,RC,84481,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T3; FREE,30200065,CDM,301,RC,84481,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC T3; FREE,30200065,CDM,301,RC,84481,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VIP - VASOACTIVE INTESTINAL PEPTIDE,30200066,CDM,301,RC,84586,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VIP - VASOACTIVE INTESTINAL PEPTIDE,30200066,CDM,301,RC,84586,HCPCS,facility,both,,,,67.5,67.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VASOPRESSIN,30200067,CDM,301,RC,84588,HCPCS,facility,both,,,,63,63,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VASOPRESSIN,30200067,CDM,301,RC,84588,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN A,30200068,CDM,301,RC,84590,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VITAMIN A,30200068,CDM,301,RC,84590,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MURAMIDASE,30200069,CDM,305,RC,85549,HCPCS,facility,both,,,,41.25,41.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MURAMIDASE,30200069,CDM,305,RC,85549,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AGGLUTININS FEBRILE,30200070,CDM,302,RC,86000,HCPCS,facility,both,,,,115,115,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AGGLUTININS FEBRILE,30200070,CDM,302,RC,86000,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALLERGEN SPECIFIC IGE,30200072,CDM,302,RC,86005,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB ID; PLATELET AB,30200073,CDM,302,RC,86022,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB ID; PLATELET AB,30200073,CDM,302,RC,86022,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTINUCLEAR AB (ANA);,30200074,CDM,302,RC,86038,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ANTINUCLEAR AB (ANA);,30200074,CDM,302,RC,86038,HCPCS,facility,both,,,,12.09,12.09,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC ANTINUCLEAR AB (ANA);,30200074,CDM,302,RC,86038,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANTINUCLEAR AB (ANA);,30200074,CDM,302,RC,86038,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTINUCLEAR AB (ANA); TITER,30200075,CDM,302,RC,86039,HCPCS,facility,both,,,,58.62,58.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTINUCLEAR AB (ANA); TITER,30200075,CDM,302,RC,86039,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,5.18,5.18,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC C-REACTIVE PROTEIN HS,30200077,CDM,302,RC,86141,HCPCS,facility,both,,,,33.49,33.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC C-REACTIVE PROTEIN HS,30200077,CDM,302,RC,86141,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC C-REACTIVE PROTEIN HS,30200077,CDM,302,RC,86141,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BETA 2 GLYCOPROTEIN I AB EA,30200078,CDM,302,RC,86146,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BETA 2 GLYCOPROTEIN I AB EA,30200078,CDM,302,RC,86146,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CARDIOLIPIN AB EA IG CLASS,30200079,CDM,302,RC,86147,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARDIOLIPIN AB EA IG CLASS,30200079,CDM,302,RC,86147,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPLEMENT; AG EA,30200080,CDM,302,RC,86160,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPLEMENT; AG EA,30200080,CDM,302,RC,86160,HCPCS,facility,both,,,,53.25,53.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPLEMENT; FCN ACTIVITY EA,30200081,CDM,302,RC,86161,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPLEMENT; FCN ACTIVITY EA,30200081,CDM,302,RC,86161,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPLEMENT; TOT HEMOLYTIC (CH50),30200082,CDM,302,RC,86162,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPLEMENT; TOT HEMOLYTIC (CH50),30200082,CDM,302,RC,86162,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CCP ANTIBODY,30200083,CDM,302,RC,86200,HCPCS,facility,both,,,,32.5,32.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CCP ANTIBODY,30200083,CDM,302,RC,86200,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CCP ANTIBODY,30200083,CDM,302,RC,86200,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC DNA AB,30200084,CDM,302,RC,86215,HCPCS,facility,both,,,,43.96,43.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA AB,30200084,CDM,302,RC,86215,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DNA AB; NATIVE OR DS,30200085,CDM,302,RC,86225,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA AB; NATIVE OR DS,30200085,CDM,302,RC,86225,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ENA ANY METHOD,30200086,CDM,302,RC,86235,HCPCS,facility,both,,,,82.5,82.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ENA ANY METHOD,30200086,CDM,302,RC,86235,HCPCS,facility,both,,,,58.62,58.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLUORESCENT AB; SCRN EA AB,30200087,CDM,302,RC,86255,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC FLUORESCENT AB; SCRN EA AB,30200087,CDM,302,RC,86255,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLUORESCENT AB; SCRN EA AB,30200087,CDM,302,RC,86255,HCPCS,facility,both,,,,460,460,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLUORESCENT AB; TITER EA AB,30200088,CDM,302,RC,86256,HCPCS,facility,both,,,,58.62,58.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLUORESCENT AB; TITER EA AB,30200088,CDM,302,RC,86256,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA QUANT; CA 19-9,30200089,CDM,302,RC,86301,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IA QUANT; CA 19-9,30200089,CDM,302,RC,86301,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA QUANT; CA 125,30200090,CDM,302,RC,86304,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA QUANT; CA 125,30200090,CDM,302,RC,86304,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAL HETEROPHILE AB,30200091,CDM,302,RC,86308,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAL HETEROPHILE AB,30200091,CDM,302,RC,86308,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC QUAL HETEROPHILE AB,30200091,CDM,302,RC,86308,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA; OTHER TUMOR AG QUAN EA,30200092,CDM,302,RC,86316,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA; OTHER TUMOR AG QUAN EA,30200092,CDM,302,RC,86316,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IA INFECTIOUS AGENT AB QUAN,30200093,CDM,302,RC,86317,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 01/01/2025 HC IEP; CROSSED,30200094,CDM,302,RC,86327,HCPCS,facility,both,,,,96.9,96.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNE COMPLEX ASSAY;,30200095,CDM,302,RC,86332,HCPCS,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNE COMPLEX ASSAY;,30200095,CDM,302,RC,86332,HCPCS,facility,both,,,,75.36,75.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM IMMUNOFIXATION ELECTROPHORES,30200096,CDM,302,RC,86334,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM IMMUNOFIXATION ELECTROPHORES,30200096,CDM,302,RC,86334,HCPCS,facility,both,,,,105,105,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNFIX E-PHORSIS/URINE/CSF,30200097,CDM,302,RC,86335,HCPCS,facility,both,,,,149,149,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IMMUNFIX E-PHORSIS/URINE/CSF,30200097,CDM,302,RC,86335,HCPCS,facility,both,,,,92.11,92.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INSULIN AB,30200098,CDM,302,RC,86337,HCPCS,facility,both,,,,77.46,77.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INSULIN AB,30200098,CDM,302,RC,86337,HCPCS,facility,both,,,,175,175,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INTRINSIC FACTOR  AB,30200099,CDM,302,RC,86340,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INTRINSIC FACTOR  AB,30200099,CDM,302,RC,86340,HCPCS,facility,both,,,,48.5,48.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ISLET CELL AB,30200100,CDM,302,RC,86341,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ISLET CELL AB,30200100,CDM,302,RC,86341,HCPCS,facility,both,,,,22.39,22.39,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC ISLET CELL AB,30200100,CDM,302,RC,86341,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELL FUNCTION ASSAY W/STIM,30200101,CDM,302,RC,86352,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELL FUNCTION ASSAY W/STIM,30200101,CDM,302,RC,86352,HCPCS,facility,both,,,,161.19,161.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MONONUCLEAR CELL ANTIGEN,30200102,CDM,302,RC,86356,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MONONUCLEAR CELL ANTIGEN,30200102,CDM,302,RC,86356,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC T CELLS; TOTAL COUNT,30200103,CDM,302,RC,86359,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC T CELLS; TOTAL COUNT,30200103,CDM,302,RC,86359,HCPCS,facility,both,,,,133,133,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T CELLS; TOTAL COUNT,30200103,CDM,302,RC,86359,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC T CELLS; ABSOL CD4 AND CD8,30200104,CDM,302,RC,86360,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC T CELLS; ABSOL CD4 AND CD8,30200104,CDM,302,RC,86360,HCPCS,facility,both,,,,141.09,141.09,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC T CELLS; ABSOL CD4 AND CD8,30200104,CDM,302,RC,86360,HCPCS,facility,both,,,,165,165,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T CELLS; ABSOL CD4 AND CD8,30200104,CDM,302,RC,86360,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC T CELLS; ABSOL CD4 COUNT,30200105,CDM,302,RC,86361,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC T CELLS; ABSOL CD4 COUNT,30200105,CDM,302,RC,86361,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MICROSOMAL AB EACH,30200106,CDM,302,RC,86376,HCPCS,facility,both,,,,34.25,34.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MICROSOMAL AB EACH,30200106,CDM,302,RC,86376,HCPCS,facility,both,,,,46.06,46.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MICROSOMAL AB EACH,30200106,CDM,302,RC,86376,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC VIRAL NEUTRALIZATION,30200107,CDM,302,RC,86382,HCPCS,facility,both,,,,870,870,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIRAL NEUTRALIZATION,30200107,CDM,302,RC,86382,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PA; TITER EA AB,30200108,CDM,302,RC,86406,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAL RHEUM FACTOR,30200109,CDM,302,RC,86430,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAL RHEUM FACTOR,30200109,CDM,302,RC,86430,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC QUAL RHEUM FACTOR,30200109,CDM,302,RC,86430,HCPCS,facility,both,,,,6.14,6.14,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC QUAL RHEUM FACTOR,30200109,CDM,302,RC,86430,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC TB TEST CELL IMMUN MEASURE,30200110,CDM,302,RC,86480,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC TB TEST CELL IMMUN MEASURE,30200110,CDM,302,RC,86480,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TB TEST CELL IMMUN MEASURE,30200110,CDM,302,RC,86480,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SYPHILIS TEST NON-TREP QUAL,30200111,CDM,302,RC,86592,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SYPHILIS TEST NON-TREP QUAL,30200111,CDM,302,RC,86592,HCPCS,facility,both,,,,14.5,14.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC SYPHILIS TEST NON-TREP QUAL,30200111,CDM,302,RC,86592,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SYPHILIS TEST NON-TREP QUANT,30200112,CDM,302,RC,86593,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SYPHILIS TEST NON-TREP QUANT,30200112,CDM,302,RC,86593,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ADENOVIRUS,30200113,CDM,302,RC,86603,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; ADENOVIRUS,30200113,CDM,302,RC,86603,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ASPERGILLUS,30200114,CDM,302,RC,86606,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ASPERGILLUS,30200114,CDM,302,RC,86606,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BACTERIUM NES,30200115,CDM,302,RC,86609,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BACTERIUM NES,30200115,CDM,302,RC,86609,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; BARTONELLA,30200116,CDM,302,RC,86611,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; BARTONELLA,30200116,CDM,302,RC,86611,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BLASTOMYCES,30200117,CDM,302,RC,86612,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BLASTOMYCES,30200117,CDM,302,RC,86612,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; BORDETELLA,30200118,CDM,302,RC,86615,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BORDETELLA,30200118,CDM,302,RC,86615,HCPCS,facility,both,,,,71.25,71.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; LYME'S (WB) CONFIRM,30200119,CDM,302,RC,86617,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; LYME'S (WB) CONFIRM,30200119,CDM,302,RC,86617,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; LYME'S DISEASE,30200120,CDM,302,RC,86618,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; LYME'S DISEASE,30200120,CDM,302,RC,86618,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BRUCELLA,30200121,CDM,302,RC,86622,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; BRUCELLA,30200121,CDM,302,RC,86622,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CANDIDA,30200122,CDM,302,RC,86628,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CANDIDA,30200122,CDM,302,RC,86628,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; CHLAMYDIA,30200123,CDM,302,RC,86631,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; CHLAMYDIA,30200123,CDM,302,RC,86631,HCPCS,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CHLAMYDIA IGM,30200124,CDM,302,RC,86632,HCPCS,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CHLAMYDIA IGM,30200124,CDM,302,RC,86632,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; COCCIDIOIDES,30200125,CDM,302,RC,86635,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; COCCIDIOIDES,30200125,CDM,302,RC,86635,HCPCS,facility,both,,,,71.5,71.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; COXIELLA BRUNETII,30200126,CDM,302,RC,86638,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; COXIELLA BRUNETII,30200126,CDM,302,RC,86638,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; CMV,30200127,CDM,302,RC,86644,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; CMV,30200127,CDM,302,RC,86644,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CMV  IGM,30200128,CDM,302,RC,86645,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CMV  IGM,30200128,CDM,302,RC,86645,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; DIPHTHERIA,30200129,CDM,302,RC,86648,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; DIPHTHERIA,30200129,CDM,302,RC,86648,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ENCEPHALITIS CALIF,30200130,CDM,302,RC,86651,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ENCEPHALITIS CALIF,30200130,CDM,302,RC,86651,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; ENCEPHALITIS E EQUINE,30200131,CDM,302,RC,86652,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; ENCEPHALITIS E EQUINE,30200131,CDM,302,RC,86652,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ENCEPHALITIS ST. LOUIS,30200132,CDM,302,RC,86653,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ENCEPHALITIS ST. LOUIS,30200132,CDM,302,RC,86653,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; ENCEPHALITIS W EQUINE,30200133,CDM,302,RC,86654,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ENCEPHALITIS W EQUINE,30200133,CDM,302,RC,86654,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; ENTEROVIRUS,30200134,CDM,302,RC,86658,HCPCS,facility,both,,,,58.5,58.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ENTEROVIRUS,30200134,CDM,302,RC,86658,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; EPSTEIN BARR VCA,30200135,CDM,302,RC,86665,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; EPSTEIN BARR VCA,30200135,CDM,302,RC,86665,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB; EPSTEIN BARR VCA,30200135,CDM,302,RC,86665,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ERLICHIA,30200136,CDM,302,RC,86666,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; ERLICHIA,30200136,CDM,302,RC,86666,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; FUNGUS NES (70),30200137,CDM,302,RC,86671,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; FUNGUS NES (70),30200137,CDM,302,RC,86671,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HELICOBACTER PYLORI,30200138,CDM,302,RC,86677,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HELICOBACTER PYLORI,30200138,CDM,302,RC,86677,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HELMINTH NES,30200139,CDM,302,RC,86682,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HELMINTH NES,30200139,CDM,302,RC,86682,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HTLV-I,30200140,CDM,302,RC,86687,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HTLV-II,30200141,CDM,302,RC,86688,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HTLV-II,30200141,CDM,302,RC,86688,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HTLV OR HIV WB,30200142,CDM,302,RC,86689,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HTLV OR HIV WB,30200142,CDM,302,RC,86689,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; HTLV OR HIV WB,30200142,CDM,302,RC,86689,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HEPATITIS D,30200143,CDM,302,RC,86692,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HEPATITIS D,30200143,CDM,302,RC,86692,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HSV 1,30200144,CDM,302,RC,86695,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HSV 1,30200144,CDM,302,RC,86695,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HSV TYPE 2,30200145,CDM,302,RC,86696,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HSV TYPE 2,30200145,CDM,302,RC,86696,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HIV-1,30200146,CDM,302,RC,86701,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HIV-1,30200146,CDM,302,RC,86701,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; HIV-1,30200146,CDM,302,RC,86701,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HBCAB - TOTAL,30200147,CDM,302,RC,86704,HCPCS,facility,both,,,,12.05,12.05,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AB; HBCAB - TOTAL,30200147,CDM,302,RC,86704,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HBCAB - TOTAL,30200147,CDM,302,RC,86704,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HBCAB - TOTAL,30200147,CDM,302,RC,86704,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB: HBCAB -  IGM AB,30200148,CDM,302,RC,86705,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB: HBCAB -  IGM AB,30200148,CDM,302,RC,86705,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB: HBCAB -  IGM AB,30200148,CDM,302,RC,86705,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB: HBCAB -  IGM AB,30200148,CDM,302,RC,86705,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,10.74,10.74,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HBEAB,30200150,CDM,302,RC,86707,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HBEAB,30200150,CDM,302,RC,86707,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HAAB - TOTAL,30200151,CDM,302,RC,86708,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB; HAAB - TOTAL,30200151,CDM,302,RC,86708,HCPCS,facility,both,,,,12.39,12.39,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AB; HAAB - TOTAL,30200151,CDM,302,RC,86708,HCPCS,facility,both,,,,36.5,36.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HAAB - TOTAL,30200151,CDM,302,RC,86708,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB: HAAB - IGM,30200152,CDM,302,RC,86709,HCPCS,facility,both,,,,30.25,30.25,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB: HAAB - IGM,30200152,CDM,302,RC,86709,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB: HAAB - IGM,30200152,CDM,302,RC,86709,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB: HAAB - IGM,30200152,CDM,302,RC,86709,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; INFLUENZA VIRUS,30200153,CDM,302,RC,86710,HCPCS,facility,both,,,,19.5,19.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; INFLUENZA VIRUS,30200153,CDM,302,RC,86710,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; LEGIONELLA,30200154,CDM,302,RC,86713,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; LEGIONELLA,30200154,CDM,302,RC,86713,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; LEISHMANIA,30200155,CDM,302,RC,86717,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; LEPTOSPIRA,30200156,CDM,302,RC,86720,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; LEPTOSPIRA,30200156,CDM,302,RC,86720,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; LCM,30200157,CDM,302,RC,86727,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; LCM,30200157,CDM,302,RC,86727,HCPCS,facility,both,,,,128,128,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; MUMPS,30200158,CDM,302,RC,86735,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; MUMPS,30200158,CDM,302,RC,86735,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB; MUMPS,30200158,CDM,302,RC,86735,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; MUMPS,30200158,CDM,302,RC,86735,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; MYCOPLASMA,30200159,CDM,302,RC,86738,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; MYCOPLASMA,30200159,CDM,302,RC,86738,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; NEISSERIA MENINGITIDIS,30200160,CDM,302,RC,86741,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; NEISSERIA MENINGITIDIS,30200160,CDM,302,RC,86741,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; PARVOVIRUS,30200161,CDM,302,RC,86747,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; PARVOVIRUS,30200161,CDM,302,RC,86747,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BABESIA MICROTI ANTIBODY,30200162,CDM,302,RC,86753,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRYPANOSOMA CRUZI IGG,30200163,CDM,302,RC,86753,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRYPANOSOMA CRUZI IGG,30200163,CDM,302,RC,86753,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; RSV,30200165,CDM,302,RC,86756,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; RSV,30200165,CDM,302,RC,86756,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; RICKETTSIA,30200166,CDM,302,RC,86757,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; RICKETTSIA,30200166,CDM,302,RC,86757,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; RUBELLA,30200167,CDM,302,RC,86762,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB; RUBELLA,30200167,CDM,302,RC,86762,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; RUBELLA,30200167,CDM,302,RC,86762,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; RUBELLA,30200167,CDM,302,RC,86762,HCPCS,facility,both,,,,28.75,28.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; RUBEOLA,30200168,CDM,302,RC,86765,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; RUBEOLA,30200168,CDM,302,RC,86765,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; RUBEOLA,30200168,CDM,302,RC,86765,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AB; RUBEOLA,30200168,CDM,302,RC,86765,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; SALMONELLA,30200169,CDM,302,RC,86768,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; SALMONELLA,30200169,CDM,302,RC,86768,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; TETANUS,30200170,CDM,302,RC,86774,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; TETANUS,30200170,CDM,302,RC,86774,HCPCS,facility,both,,,,37.5,37.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; TOXOPLASMA,30200171,CDM,302,RC,86777,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; TOXOPLASMA,30200171,CDM,302,RC,86777,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; TOXOPLASMA IGM,30200172,CDM,302,RC,86778,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; TOXOPLASMA IGM,30200172,CDM,302,RC,86778,HCPCS,facility,both,,,,59,59,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TREPONEMA PALLIDUM,30200173,CDM,302,RC,86780,HCPCS,facility,both,,,,35.59,35.59,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TREPONEMA PALLIDUM,30200173,CDM,302,RC,86780,HCPCS,facility,both,,,,14.5,14.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC TREPONEMA PALLIDUM,30200173,CDM,302,RC,86780,HCPCS,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TREPONEMA PALLIDUM,30200173,CDM,302,RC,86780,HCPCS,facility,both,,,,13.24,13.24,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AB; TRICHINELLA,30200174,CDM,302,RC,86784,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; TRICHINELLA,30200174,CDM,302,RC,86784,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; VARICELLA-ZOSTER,30200175,CDM,302,RC,86787,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; VARICELLA-ZOSTER,30200175,CDM,302,RC,86787,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB; VARICELLA-ZOSTER,30200175,CDM,302,RC,86787,HCPCS,facility,both,,,,48.5,48.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WEST NILE VIRUS AB IGM,30200176,CDM,302,RC,86788,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WEST NILE VIRUS AB IGM,30200176,CDM,302,RC,86788,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WEST NILE VIRUS ANTIBODY,30200177,CDM,302,RC,86789,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DENGUE FEVER ANTIBODY, IGG",30200178,CDM,302,RC,86790,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DENGUE FEVER ANTIBODY, IGG",30200178,CDM,302,RC,86790,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS E ANTIBODY IGG,30200179,CDM,302,RC,86790,HCPCS,facility,both,,,,75.36,75.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS E ANTIBODY IGG,30200179,CDM,302,RC,86790,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS E ANTIBODY IGM,30200180,CDM,302,RC,86790,HCPCS,facility,both,,,,117.23,117.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS E ANTIBODY IGM,30200180,CDM,302,RC,86790,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHIKUNGUNYA ANTIBODY W REFLEX,30200181,CDM,302,RC,86790,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HUNTAVIRUS ANTIBODIES ELISA,30200182,CDM,302,RC,86790,HCPCS,facility,both,,,,167,167,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HUNTAVIRUS ANTIBODIES ELISA,30200182,CDM,302,RC,86790,HCPCS,facility,both,,,,154.91,154.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC HERPES 8 IGG AB, IFA",30200183,CDM,302,RC,86790,HCPCS,facility,both,,,,191,191,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC HERPES 8 IGG AB, IFA",30200183,CDM,302,RC,86790,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"DEAC 2/8/2017 HC PARAINFLUENZA AB TYPE 1,2,3",30200184,CDM,302,RC,86790,HCPCS,facility,both,,,,442.26,442.26,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB: THYROGLOBULIN,30200186,CDM,302,RC,86800,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB: THYROGLOBULIN,30200186,CDM,302,RC,86800,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AB: THYROGLOBULIN,30200186,CDM,302,RC,86800,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS C AB,30200187,CDM,302,RC,86803,HCPCS,facility,both,,,,28.5,28.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS C AB,30200187,CDM,302,RC,86803,HCPCS,facility,both,,,,27.5,27.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC HEPATITIS C AB,30200187,CDM,302,RC,86803,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEPATITIS C AB,30200187,CDM,302,RC,86803,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS C CONFIRMATION,30200188,CDM,302,RC,86804,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HLA TYPE; A B C SGL AG,30200189,CDM,302,RC,86812,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA TYPE; A B C SGL AG,30200189,CDM,302,RC,86812,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COOMBS TEST INDIRECT QUAL,30200191,CDM,300,RC,86885,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COOMBS TEST INDIRECT QUAL,30200191,CDM,300,RC,86885,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FFP THAWING EA UNIT,30200192,CDM,300,RC,86927,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FFP THAWING EA UNIT,30200192,CDM,300,RC,86927,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM PRETX; DRUG INCUBATE,30200193,CDM,300,RC,86975,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SERUM PRETX; DRUG INCUBATE,30200193,CDM,300,RC,86975,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS DELTA AG EIA,30200194,CDM,306,RC,87380,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS DELTA AG EIA,30200194,CDM,306,RC,87380,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLAMYDIA P DIR NA PROBE,30200195,CDM,306,RC,87485,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHLAMYDIA P DIR NA PROBE,30200195,CDM,306,RC,87485,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEP-C NA QUAN,30200196,CDM,306,RC,87522,HCPCS,facility,both,,,,42.84,42.84,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HEP-C NA QUAN,30200196,CDM,306,RC,87522,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEP-C NA QUAN,30200196,CDM,306,RC,87522,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEP-C NA QUAN,30200196,CDM,306,RC,87522,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HERPES 6 AMPLIF NA PROBE,30200197,CDM,306,RC,87532,HCPCS,facility,both,,,,195,195,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HIV-1 NA QUAN,30200198,CDM,306,RC,87536,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HIV-1 NA QUAN,30200198,CDM,306,RC,87536,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HIV-1 NA QUAN,30200198,CDM,306,RC,87536,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYCOPLASMA AMPLIF NA PROBE,30200199,CDM,306,RC,87581,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYCOPLASMA AMPLIF NA PROBE,30200199,CDM,306,RC,87581,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HPV HI RISK TYPES,30200200,CDM,306,RC,87624,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HPV HI RISK TYPES,30200200,CDM,306,RC,87624,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTI-PHOSPHATIDYLSERINE AB,30200250,CDM,302,RC,86148,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANTI-PHOSPHATIDYLSERINE AB,30200250,CDM,302,RC,86148,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IA INFECTIOUS AGENT SGL STEP,30200254,CDM,302,RC,86318,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IMMUNODIFFUSION; NES,30200257,CDM,302,RC,86329,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PA; SCREEN EA AB,30200258,CDM,302,RC,86403,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PA; SCREEN EA AB,30200258,CDM,302,RC,86403,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAN RHEUM FACTOR,30200259,CDM,302,RC,86431,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC QUAN RHEUM FACTOR,30200259,CDM,302,RC,86431,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CRYPTOCOCCUS,30200260,CDM,302,RC,86641,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; CRYPTOCOCCUS,30200260,CDM,302,RC,86641,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; EB EARLY AG VIRUS,30200261,CDM,302,RC,86663,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; EB EARLY AG VIRUS,30200261,CDM,302,RC,86663,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; EBNA,30200262,CDM,302,RC,86664,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; EBNA,30200262,CDM,302,RC,86664,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; FRANCISELLA TULARENSIS,30200263,CDM,302,RC,86668,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; HISTOPLASMA,30200265,CDM,302,RC,86698,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; HISTOPLASMA,30200265,CDM,302,RC,86698,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HIV-1/HIV-2 SINGLE RESULT,30200266,CDM,302,RC,86703,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HIV-1/HIV-2 SINGLE RESULT,30200266,CDM,302,RC,86703,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASO ; TITER,30200268,CDM,302,RC,86060,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASO ; TITER,30200268,CDM,302,RC,86060,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DNA AB; SS,30200269,CDM,302,RC,86226,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA AB; SS,30200269,CDM,302,RC,86226,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELL ENUMERATION & ID,30200272,CDM,302,RC,86152,HCPCS,facility,both,,,,667,667,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELL ENUMERATION & ID,30200272,CDM,302,RC,86152,HCPCS,facility,both,,,,795.51,795.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB ID; LEUKOCYTE AB,30200275,CDM,302,RC,86021,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB ID; LEUKOCYTE AB,30200275,CDM,302,RC,86021,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LHR TEST,30200279,CDM,302,RC,86343,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SKIN TEST; TB ID,30200280,CDM,302,RC,86580,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRA SCREEN; QUICK METHOD,30200286,CDM,310,RC,86808,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PRA SCREEN; QUICK METHOD,30200286,CDM,310,RC,86808,HCPCS,facility,both,,,,98.39,98.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  S CEREVISIAE AB,30200289,CDM,302,RC,86671,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  S CEREVISIAE AB,30200289,CDM,302,RC,86671,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC E HISTOLYTICA AB,30200290,CDM,302,RC,86753,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC E HISTOLYTICA AB,30200290,CDM,302,RC,86753,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED IMMUN PROC (1690),30200291,CDM,302,RC,86849,HCPCS,facility,both,,,,3537.91,3537.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED IMMUN PROC (1690),30200291,CDM,302,RC,86849,HCPCS,facility,both,,,,3180,3180,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC AB, VRUS NES (50)",30200292,CDM,302,RC,86790,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC AB, VRUS NES (50)",30200292,CDM,302,RC,86790,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TB AG RESPONSE T-CELL SUSP,30200293,CDM,302,RC,86481,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TB AG RESPONSE T-CELL SUSP,30200293,CDM,302,RC,86481,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC TB AG RESPONSE T-CELL SUSP,30200293,CDM,302,RC,86481,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC TB AG RESPONSE T-CELL SUSP,30200293,CDM,302,RC,86481,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; FUNGUS NES (5),30200295,CDM,302,RC,86671,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; FUNGUS NES (60),30200296,CDM,302,RC,86671,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; FUNGUS NES (60),30200296,CDM,302,RC,86671,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; FUNGUS NES (65),30200297,CDM,302,RC,86671,HCPCS,facility,both,,,,136.07,136.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; PROTOZOA NES (15),30200298,CDM,302,RC,86753,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; PROTOZOA NES (15),30200298,CDM,302,RC,86753,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB; VIRUS  NES (15),30200299,CDM,302,RC,86790,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; VIRUS NES (35),30200300,CDM,302,RC,86790,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; VIRUS NES (35),30200300,CDM,302,RC,86790,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC AB, VIRUS NES (10)",30200301,CDM,302,RC,86790,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC AB, VIRUS NES (10)",30200301,CDM,302,RC,86790,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC HC AB, VIRUS NES (20)",30200302,CDM,302,RC,86790,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC HC AB, VIRUS NES (20)",30200302,CDM,302,RC,86790,HCPCS,facility,both,,,,39.64,39.64,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC AB, VIRUS NES (165)",30200303,CDM,302,RC,86790,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; PROTOZOA NES (20),30200304,CDM,302,RC,86753,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB; PROTOZOA NES (20),30200304,CDM,302,RC,86753,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ALLG SPEC IGE RECOMB EA,30200305,CDM,302,RC,86008,HCPCS,facility,both,,,,58.62,58.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTIBODY; ZIKA VIRUS, IGM",30200306,CDM,302,RC,86794,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC ANTIBODY; ZIKA VIRUS, IGM",30200306,CDM,302,RC,86794,HCPCS,facility,both,,,,285,285,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP",30200307,CDM,302,RC,86769,HCPCS,facility,both,,,,40.32,40.32,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP",30200307,CDM,302,RC,86769,HCPCS,facility,both,,,,36.5,36.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ACTIN ANTIBODY EACH,30200308,CDM,302,RC,86015,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANCA SCREEN EACH ANTIBODY,30200309,CDM,302,RC,86036,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AQUAPORIN-4 ANTB CBA EACH,30200310,CDM,302,RC,86052,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EMA EACH IG CLASS,30200311,CDM,302,RC,86231,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DGP ANTIBODY EACH IG CLASS,30200312,CDM,302,RC,86258,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOG-IGG1 ANTB CBA EACH,30200313,CDM,302,RC,86362,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISS TRNSGL TMNASE EA IG CLASS,30200314,CDM,302,RC,86364,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MITOCHONDRIAL ANTIBODY EACH,30200315,CDM,302,RC,86381,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AQAPRN-4 ANTB FLO CYTMTRY EA,30200318,CDM,302,RC,86053,HCPCS,facility,both,,,,734.8,734.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VOLTAGE-GTD CA CHNL ANTB EA,30200320,CDM,302,RC,86596,HCPCS,facility,both,,,,1241.41,1241.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MOG-IGG1 ANTIBODY FLOW CYTOMETRY, EA",30200323,CDM,302,RC,86363,HCPCS,facility,both,,,,297.26,297.26,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLUORESCENT NONINFECT AB; SCRN EA AB,30200326,CDM,302,RC,86255,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (49)",30200327,CDM,302,RC,86596,HCPCS,facility,both,,,,102.58,102.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (33)",30200328,CDM,302,RC,86596,HCPCS,facility,both,,,,69.09,69.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY,30200333,CDM,302,RC,86041,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY,30200334,CDM,302,RC,86042,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY,30200335,CDM,302,RC,86043,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MUSCLE-SPECIFIC KINASE (MUSK) ANTIBODY,30200336,CDM,302,RC,86366,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC-ANCA SCREEN EACH ANTIBODY TITER (5),30200337,CDM,302,RC,86037,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC-ANCA SCREEN EACH ANTIBODY TITER (27),30200338,CDM,302,RC,86037,HCPCS,facility,both,,,,56.52,56.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOG -IGG1 FACS ASSAY (194),30200339,CDM,302,RC,86363,HCPCS,facility,both,,,,406.13,406.13,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AQAPRN IGG1 FACS ASSAY (145),30200340,CDM,302,RC,86053,HCPCS,facility,both,,,,303.55,303.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC STREP PNEUMONIAE IGG AB, 23 SEROTYPES, MULTI IA, QUANT",30200344,CDM,302,RC,86581,HCPCS,facility,both,,,,81.64,81.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC STREP PNEUMONIAE IGG AB, 14 SEROTYPES, MULTI IA, QUANT",30200346,CDM,302,RC,86581,HCPCS,facility,both,,,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC T. CRUZI (CONFIRMATION),30260007,CDM,302,RC,86753,HCPCS,facility,both,,,,54.43,54.43,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LAB HEMATOLOGY,30500000,CDM,305,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC OCCULT BLOOD OTHER SOURCES,30500001,CDM,301,RC,82271,HCPCS,facility,both,,,,5.25,5.25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OCCULT BLOOD OTHER SOURCES,30500001,CDM,301,RC,82271,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GONADOTROPIN; FSH,30500002,CDM,301,RC,83001,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GONADOTROPIN; FSH,30500002,CDM,301,RC,83001,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GONADOTROPIN; FSH,30500002,CDM,301,RC,83001,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC GONADOTROPIN; FSH,30500002,CDM,301,RC,83001,HCPCS,facility,both,,,,18.58,18.58,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC GONADOTROPIN; LUTEINIZING HORMONE,30500003,CDM,301,RC,83002,HCPCS,facility,both,,,,18.52,18.52,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC GONADOTROPIN; LUTEINIZING HORMONE,30500003,CDM,301,RC,83002,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GONADOTROPIN; LUTEINIZING HORMONE,30500003,CDM,301,RC,83002,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC GONADOTROPIN; LUTEINIZING HORMONE,30500003,CDM,301,RC,83002,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HGB; PLASMA,30500004,CDM,301,RC,83051,HCPCS,facility,both,,,,19.5,19.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HGB; PLASMA,30500004,CDM,301,RC,83051,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASSAY PH BODY FLUID NOS,30500005,CDM,301,RC,83986,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASSAY PH BODY FLUID NOS,30500005,CDM,301,RC,83986,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROGESTERONE ASSAY,30500006,CDM,301,RC,84144,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROGESTERONE ASSAY,30500006,CDM,301,RC,84144,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HCG; QUAL,30500007,CDM,301,RC,84703,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC HCG; QUAL,30500007,CDM,301,RC,84703,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HCG; QUAL,30500007,CDM,301,RC,84703,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HCG; QUAL,30500007,CDM,301,RC,84703,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WBC W AUTO DIFF,30500008,CDM,305,RC,85004,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WBC W AUTO DIFF,30500008,CDM,305,RC,85004,HCPCS,facility,both,,,,19,19,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BL SMEAR W/DIFF WBC COUNT,30500009,CDM,305,RC,85007,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BL SMEAR W/DIFF WBC COUNT,30500009,CDM,305,RC,85007,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC BL SMEAR W/DIFF WBC COUNT,30500009,CDM,305,RC,85007,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BL SMEAR W/O DIFF WBC COUNT,30500010,CDM,305,RC,85008,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BL SMEAR W/O DIFF WBC COUNT,30500010,CDM,305,RC,85008,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEMATOCRIT,30500012,CDM,305,RC,85014,HCPCS,facility,both,,,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HEMATOCRIT,30500012,CDM,305,RC,85014,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEMATOCRIT,30500012,CDM,305,RC,85014,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMATOCRIT,30500012,CDM,305,RC,85014,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEMOGLOBIN,30500013,CDM,305,RC,85018,HCPCS,facility,both,,,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HEMOGLOBIN,30500013,CDM,305,RC,85018,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOGLOBIN,30500013,CDM,305,RC,85018,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPL CBC  W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC COMPL CBC  W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPL CBC  W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,7.77,7.77,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC COMPL CBC  W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPL CBC  W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,7.5,7.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,6.47,6.47,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOMATED WBC,30500017,CDM,305,RC,85048,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOMATED WBC,30500017,CDM,305,RC,85048,HCPCS,facility,both,,,,18.5,18.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AUTOMATED PLATELET COUNT,30500018,CDM,305,RC,85049,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AUTOMATED PLATELET COUNT,30500018,CDM,305,RC,85049,HCPCS,facility,both,,,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RETICULATED PLATELET ASSAY,30500019,CDM,305,RC,85055,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RETICULATED PLATELET ASSAY,30500019,CDM,305,RC,85055,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROMOGENIC SUBSTRATE ASSAY,30500021,CDM,305,RC,85130,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROMOGENIC SUBSTRATE ASSAY,30500021,CDM,305,RC,85130,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR II PROTHROMBIN SPECIF,30500022,CDM,305,RC,85210,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR II PROTHROMBIN SPECIF,30500022,CDM,305,RC,85210,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR V,30500023,CDM,305,RC,85220,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR V,30500023,CDM,305,RC,85220,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR VII,30500024,CDM,305,RC,85230,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR VII,30500024,CDM,305,RC,85230,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD CLOT FACTOR VIII TEST,30500025,CDM,305,RC,85240,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD CLOT FACTOR VIII TEST,30500025,CDM,305,RC,85240,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR VIII RISTOCETIN COFACT,30500026,CDM,305,RC,85245,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR VIII RISTOCETIN COFACT,30500026,CDM,305,RC,85245,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING: FACTOR VIII VW FACTOR AG,30500027,CDM,305,RC,85246,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING: FACTOR VIII VW FACTOR AG,30500027,CDM,305,RC,85246,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FACTOR 8 VWF MULTIMRIC,30500028,CDM,305,RC,85247,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FACTOR 8 VWF MULTIMRIC,30500028,CDM,305,RC,85247,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR IX,30500029,CDM,305,RC,85250,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR IX,30500029,CDM,305,RC,85250,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR X,30500030,CDM,305,RC,85260,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR X,30500030,CDM,305,RC,85260,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR XI,30500031,CDM,305,RC,85270,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR XI,30500031,CDM,305,RC,85270,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR XII,30500032,CDM,305,RC,85280,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR XII,30500032,CDM,305,RC,85280,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR XIII SCREEN SOLUBLE,30500033,CDM,305,RC,85291,HCPCS,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING; FACTOR XIII SCREEN SOLUBLE,30500033,CDM,305,RC,85291,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING: PREKALLIKREIN ASSAY,30500034,CDM,305,RC,85292,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING: PREKALLIKREIN ASSAY,30500034,CDM,305,RC,85292,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANTITHROMBIN III ACTIVITY ASSAY,30500035,CDM,305,RC,85300,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANTITHROMBIN III ACTIVITY ASSAY,30500035,CDM,305,RC,85300,HCPCS,facility,both,,,,39.77,39.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTITHROMBIN III ANTIGEN ASSAY,30500036,CDM,305,RC,85301,HCPCS,facility,both,,,,35.59,35.59,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ANTITHROMBIN III ANTIGEN ASSAY,30500036,CDM,305,RC,85301,HCPCS,facility,both,,,,53.5,53.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING INHIBITOR; PROTEIN C AG,30500037,CDM,305,RC,85302,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING INHIBITOR; PROTEIN C AG,30500037,CDM,305,RC,85302,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY,30500038,CDM,305,RC,85303,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY,30500038,CDM,305,RC,85303,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING INHIBITOR; PROTEIN S TOTAL,30500039,CDM,305,RC,85305,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING INHIBITOR; PROTEIN S TOTAL,30500039,CDM,305,RC,85305,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING INHIBITOR PROTEIN S FREE,30500040,CDM,305,RC,85306,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACTIVATED PROTEIN C RESISTANCE,30500041,CDM,305,RC,85307,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ACTIVATED PROTEIN C RESISTANCE,30500041,CDM,305,RC,85307,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FACTOR INHIBITOR TEST,30500042,CDM,305,RC,85335,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FACTOR INHIBITOR TEST,30500042,CDM,305,RC,85335,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC D-DIMER - QUAN,30500043,CDM,305,RC,85379,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC D-DIMER - QUAN,30500043,CDM,305,RC,85379,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC D-DIMER - QUAN,30500043,CDM,305,RC,85379,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FIBRINOGEN; ACTIVITY,30500044,CDM,305,RC,85384,HCPCS,facility,both,,,,18.84,18.84,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FIBRINOGEN; ACTIVITY,30500044,CDM,305,RC,85384,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FIBRINOGEN; ACTIVITY,30500044,CDM,305,RC,85384,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC FIBRINOGEN; ANTIGEN,30500045,CDM,305,RC,85385,HCPCS,facility,both,,,,33.49,33.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FIBRINOGEN; ANTIGEN,30500045,CDM,305,RC,85385,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FIBRINOLYSINS OR COAG SCREEN,30500046,CDM,305,RC,85390,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FIBRINOLYSINS OR COAG SCREEN,30500046,CDM,305,RC,85390,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING FUNCT ACTIVITY,30500047,CDM,305,RC,85397,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CLOTTING FUNCT ACTIVITY,30500047,CDM,305,RC,85397,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALPHA-2-ANTIPLASMIN,30500048,CDM,305,RC,85410,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ALPHA-2-ANTIPLASMIN,30500048,CDM,305,RC,85410,HCPCS,facility,both,,,,82.5,82.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PLASMINOGEN ACTIVATOR,30500049,CDM,305,RC,85415,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLASMINOGEN ACTIVATOR,30500049,CDM,305,RC,85415,HCPCS,facility,both,,,,47.5,47.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FUNCTIONAL PLASMINOGEN,30500050,CDM,305,RC,85420,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FUNCTIONAL PLASMINOGEN,30500050,CDM,305,RC,85420,HCPCS,facility,both,,,,48.15,48.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLASMINOGEN ANTIGEN LEVEL,30500051,CDM,305,RC,85421,HCPCS,facility,both,,,,33.49,33.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLASMINOGEN ANTIGEN LEVEL,30500051,CDM,305,RC,85421,HCPCS,facility,both,,,,55.5,55.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEINZ BODIES; DIRECT,30500052,CDM,305,RC,85441,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEINZ BODIES; DIRECT,30500052,CDM,305,RC,85441,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC K-B STAIN FOR FETAL HGB,30500053,CDM,305,RC,85460,HCPCS,facility,both,,,,48.15,48.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC K-B STAIN FOR FETAL HGB,30500053,CDM,305,RC,85460,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPARIN ASSAY,30500055,CDM,305,RC,85520,HCPCS,facility,both,,,,48.15,48.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPARIN ASSAY,30500055,CDM,305,RC,85520,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPARIN NEUTRALIZATION,30500056,CDM,305,RC,85525,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPARIN NEUTRALIZATION,30500056,CDM,305,RC,85525,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IRON STAIN PERIPHERAL BLOOD,30500057,CDM,305,RC,85536,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLT AGGREGATION (IN VITRO) EA AGENT,30500060,CDM,305,RC,85576,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLT AGGREGATION (IN VITRO) EA AGENT,30500060,CDM,305,RC,85576,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC RUSSELL VIPER VENOM TIME; UNDILUTED,30500063,CDM,305,RC,85612,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RUSSELL VIPER VENOM TIME; UNDILUTED,30500063,CDM,305,RC,85612,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RUSSELL VIPER VENOM TIME; DILUTED,30500064,CDM,305,RC,85613,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RUSSELL VIPER VENOM TIME; DILUTED,30500064,CDM,305,RC,85613,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC REPTILASE TEST,30500065,CDM,305,RC,85635,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC REPTILASE TEST,30500065,CDM,305,RC,85635,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NONAUTO ERYTHROCYTE SED RATE,30500066,CDM,305,RC,85651,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NONAUTO ERYTHROCYTE SED RATE,30500066,CDM,305,RC,85651,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,14.5,14.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THROMBIN TIME; PLASMA,30500068,CDM,305,RC,85670,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THROMBIN TIME; PLASMA,30500068,CDM,305,RC,85670,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,6.01,6.01,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,14.5,14.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC VISCOSITY,30500070,CDM,305,RC,85810,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VISCOSITY,30500070,CDM,305,RC,85810,HCPCS,facility,both,,,,60.5,60.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEMOLYTIC ANEMIA EVALUATION,30500073,CDM,305,RC,85999,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AB ID; PLATELET IG ASSAY,30500075,CDM,302,RC,86023,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AB ID; PLATELET IG ASSAY,30500075,CDM,302,RC,86023,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC B CELLS TOTAL COUNT,30500076,CDM,302,RC,86355,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC B CELLS TOTAL COUNT,30500076,CDM,302,RC,86355,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NK CELLS TOTAL COUNT,30500077,CDM,302,RC,86357,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NK CELLS TOTAL COUNT,30500077,CDM,302,RC,86357,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STEM CELLS TOTAL COUNT,30500078,CDM,302,RC,86367,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STEM CELLS TOTAL COUNT,30500078,CDM,302,RC,86367,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC AB SCRN EA TECHIQ,30500079,CDM,300,RC,86850,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC AB SCRN EA TECHIQ,30500079,CDM,300,RC,86850,HCPCS,facility,both,,,,38.5,38.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CONCENTRATION FOR INFECT AGNT,30500080,CDM,306,RC,87015,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CONCENTRATION FOR INFECT AGNT,30500080,CDM,306,RC,87015,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMEAR FOR EOSINOPHIL,30500081,CDM,305,RC,85999,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SMEAR FOR EOSINOPHIL,30500081,CDM,305,RC,85999,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FIBRIN DEGRADATION PRODUCTS,30500153,CDM,305,RC,85362,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEXAGNAL PHOSPH PLTLT NEUTRL,30500155,CDM,305,RC,85598,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEXAGNAL PHOSPH PLTLT NEUTRL,30500155,CDM,305,RC,85598,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MANUAL CELL COUNT EACH,30500161,CDM,305,RC,85032,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MANUAL CELL COUNT EACH,30500161,CDM,305,RC,85032,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RETICYTE/HGB CONCENTRATE,30500163,CDM,305,RC,85046,HCPCS,facility,both,,,,33.49,33.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR VIII RELATED ANTIGEN,30500165,CDM,305,RC,85244,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOTTING; FACTOR VIII RELATED ANTIGEN,30500165,CDM,305,RC,85244,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COAG TIME; ACTIVATED,30500168,CDM,305,RC,85347,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COAG TIME; ACTIVATED,30500168,CDM,305,RC,85347,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EUGLOBULIN LYSIS,30500169,CDM,305,RC,85360,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EUGLOBULIN LYSIS,30500169,CDM,305,RC,85360,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OSMOTIC FRAGILITY RBC; UNINCUBATED,30500172,CDM,305,RC,85555,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OSMOTIC FRAGILITY RBC; UNINCUBATED,30500172,CDM,305,RC,85555,HCPCS,facility,both,,,,43.96,43.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LAB BACTERIOLOY AND MICROBIOLOGY,30600000,CDM,306,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASO; SCREEN,30600001,CDM,302,RC,86063,HCPCS,facility,both,,,,25.12,25.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASO; SCREEN,30600001,CDM,302,RC,86063,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AEROB BACTERIAL BLOOD CULTURE,30600002,CDM,306,RC,87040,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AEROB BACTERIAL BLOOD CULTURE,30600002,CDM,306,RC,87040,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AEROB BACTERIAL BLOOD CULTURE,30600002,CDM,306,RC,87040,HCPCS,facility,both,,,,10.32,10.32,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC AEROB BACTERIA CULTURE STOOL,30600003,CDM,306,RC,87045,HCPCS,facility,both,,,,17.3,17.3,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AEROB BACTERIA CULTURE STOOL,30600003,CDM,306,RC,87045,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE,30600004,CDM,306,RC,87046,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE,30600004,CDM,306,RC,87046,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,8.62,8.62,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC BACT CULT; QUAN AEROBIC,30600006,CDM,306,RC,87071,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BACT CULT; QUAN AEROBIC,30600006,CDM,306,RC,87071,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC BACT CULT; QUAN AEROBIC,30600006,CDM,306,RC,87071,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANAEROB BACT CULTURE W ID,30600007,CDM,306,RC,87075,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ANAEROB BACT CULTURE W ID,30600007,CDM,306,RC,87075,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BC - ANAEROBE - ADDTL ID,30600008,CDM,306,RC,87076,HCPCS,facility,both,,,,71.5,71.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BC - ANAEROBE - ADDTL ID,30600008,CDM,306,RC,87076,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,8.08,8.08,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC CULTURE P PATHOG - SCREEN,30600010,CDM,306,RC,87081,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE P PATHOG - SCREEN,30600010,CDM,306,RC,87081,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,37.5,37.5,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,8.07,8.07,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINE BACTERIA CULTURE,30600012,CDM,306,RC,87088,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC URINE BACTERIA CULTURE,30600012,CDM,306,RC,87088,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULT FUNGUS W P ID; SKIN HR NL,30600013,CDM,306,RC,87101,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULT FUNGUS W P ID; SKIN HR NL,30600013,CDM,306,RC,87101,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FUNGUS CULTURE NOT BLOOD,30600014,CDM,306,RC,87102,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FUNGUS CULTURE NOT BLOOD,30600014,CDM,306,RC,87102,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FUNGUS CULTURE BLOOD,30600015,CDM,306,RC,87103,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FUNGUS CULTURE BLOOD,30600015,CDM,306,RC,87103,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FUNGUS CULTURE DEF I.D YEAST,30600016,CDM,306,RC,87106,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FUNGUS CULTURE DEF I.D YEAST,30600016,CDM,306,RC,87106,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FUNGUS CULTURE DEF ID  MOLD,30600017,CDM,306,RC,87107,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FUNGUS CULTURE DEF ID  MOLD,30600017,CDM,306,RC,87107,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE MYCOPLASMA,30600018,CDM,306,RC,87109,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE MYCOPLASMA,30600018,CDM,306,RC,87109,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLAMYDIA CULTURE,30600019,CDM,306,RC,87110,HCPCS,facility,both,,,,91,91,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLAMYDIA CULTURE,30600019,CDM,306,RC,87110,HCPCS,facility,both,,,,64.9,64.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE AFB - ISOL & ID,30600020,CDM,306,RC,87116,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE AFB - ISOL & ID,30600020,CDM,306,RC,87116,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULT MYCOBACTERIA DEFIN ID EA,30600021,CDM,306,RC,87118,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULT MYCOBACTERIA DEFIN ID EA,30600021,CDM,306,RC,87118,HCPCS,facility,both,,,,159.1,159.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE; GLC/HPLC,30600022,CDM,306,RC,87143,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULTURE; GLC/HPLC,30600022,CDM,306,RC,87143,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CULTURE; IMMUNOLOGIC,30600023,CDM,306,RC,87147,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULTURE; IMMUNOLOGIC,30600023,CDM,306,RC,87147,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA/RNA DIRECT PROBE,30600024,CDM,306,RC,87149,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DNA/RNA DIRECT PROBE,30600024,CDM,306,RC,87149,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA/RNA DIRECT PROBE,30600024,CDM,306,RC,87149,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CULTURE; PULSE FLD GEL ID,30600025,CDM,306,RC,87152,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULTURE; PULSE FLD GEL ID,30600025,CDM,306,RC,87152,HCPCS,facility,both,,,,142.35,142.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ADENOVIRUS GENOTYPE,30600027,CDM,306,RC,87153,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULTURE; OTHER METHODS,30600028,CDM,306,RC,87158,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CULTURE; OTHER METHODS,30600028,CDM,306,RC,87158,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PINWORM EXAM,30600029,CDM,306,RC,87172,HCPCS,facility,both,,,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PINWORM EXAM,30600029,CDM,306,RC,87172,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OVA & PARASITES DIR SMR W ID,30600030,CDM,306,RC,87177,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC OVA & PARASITES DIR SMR W ID,30600030,CDM,306,RC,87177,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SENSITIVITY - AGAR DILUTION/AGENT,30600031,CDM,306,RC,87181,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SENSITIVITY - AGAR DILUTION/AGENT,30600031,CDM,306,RC,87181,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SENSITIVITY - DISK PER PLATE,30600032,CDM,306,RC,87184,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SENSITIVITY - DISK PER PLATE,30600032,CDM,306,RC,87184,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SENSTITIVITY - ENZYME DETECT,30600033,CDM,306,RC,87185,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SENSTITIVITY - ENZYME DETECT,30600033,CDM,306,RC,87185,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MICROBE SUSCEPTIBILITIES MIC,30600034,CDM,306,RC,87186,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MICROBE SUSCEPTIBILITIES MIC,30600034,CDM,306,RC,87186,HCPCS,facility,both,,,,120.35,120.35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MICROBE SUSCEPTIBILITIES MIC,30600034,CDM,306,RC,87186,HCPCS,facility,both,,,,8.65,8.65,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC MICROBE SUSCEPTIBILITIES MIC,30600034,CDM,306,RC,87186,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC SENSITIVITY - MACROBROTH EA AGNT,30600035,CDM,306,RC,87188,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SENSITIVITY - MACROBROTH EA AGNT,30600035,CDM,306,RC,87188,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM BACTERICIDAL TITER,30600036,CDM,306,RC,87197,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SERUM BACTERICIDAL TITER,30600036,CDM,306,RC,87197,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SMEAR - GRAM OR GIEMSA,30600037,CDM,306,RC,87205,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMEAR - GRAM OR GIEMSA,30600037,CDM,306,RC,87205,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SMEAR - GRAM OR GIEMSA,30600037,CDM,306,RC,87205,HCPCS,facility,both,,,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC SMEAR - GRAM OR GIEMSA,30600037,CDM,306,RC,87205,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC SMEAR; FLUORESCENT OR AFB STAIN,30600038,CDM,306,RC,87206,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SMEAR; FLUORESCENT OR AFB STAIN,30600038,CDM,306,RC,87206,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMEAR SPECIAL STAIN,30600039,CDM,306,RC,87207,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SMEAR SPECIAL STAIN,30600039,CDM,306,RC,87207,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMEAR - INFECTIOUS WET MOUNT,30600040,CDM,306,RC,87210,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMEAR - INFECTIOUS WET MOUNT,30600040,CDM,306,RC,87210,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC KOH FOR FUNGI/PARASITES/MITES,30600041,CDM,306,RC,87220,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KOH FOR FUNGI/PARASITES/MITES,30600041,CDM,306,RC,87220,HCPCS,facility,both,,,,7.5,7.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIRUS ISOLATE; TISSUE CULT INOC,30600042,CDM,306,RC,87252,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIRUS ISOLATE; TISSUE CULT INOC,30600042,CDM,306,RC,87252,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VIRUS ISOLATE; ADDTL OR ID,30600043,CDM,306,RC,87253,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VIRUS ISOLATE; ADDTL OR ID,30600043,CDM,306,RC,87253,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIRUS ISOL SHELL VIAL TECHN,30600044,CDM,306,RC,87254,HCPCS,facility,both,,,,42.75,42.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC VIRUS ISOL SHELL VIAL TECHN,30600044,CDM,306,RC,87254,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENET VIRUS ISOLATE HSV,30600045,CDM,306,RC,87255,HCPCS,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENET VIRUS ISOLATE HSV,30600045,CDM,306,RC,87255,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ADENOVIRUS AG BY IF,30600046,CDM,306,RC,87260,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ADENOVIRUS AG BY IF,30600046,CDM,306,RC,87260,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BORDATELLA P AG BY DFA,30600047,CDM,306,RC,87265,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BORDATELLA P AG BY DFA,30600047,CDM,306,RC,87265,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INFLUENZA B AG BY IF,30600048,CDM,306,RC,87275,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INFLUENZA B AG BY IF,30600048,CDM,306,RC,87275,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INFLUENZA A AG BY DFA,30600049,CDM,306,RC,87276,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INFLUENZA A AG BY DFA,30600049,CDM,306,RC,87276,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEGIONELLA P AG BY DFA,30600050,CDM,306,RC,87278,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEGIONELLA P AG BY DFA,30600050,CDM,306,RC,87278,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PARAINFLUENZA AG BY DFA,30600051,CDM,306,RC,87279,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PARAINFLUENZA AG BY DFA,30600051,CDM,306,RC,87279,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RSV AG BY IF,30600052,CDM,306,RC,87280,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RSV AG BY IF,30600052,CDM,306,RC,87280,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PNEUMOCYSTIS C AG BY IF,30600053,CDM,306,RC,87281,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VARICELLA ZOSTER AG BY DFA,30600054,CDM,306,RC,87290,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VARICELLA ZOSTER AG BY DFA,30600054,CDM,306,RC,87290,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INF AGENT MULTI ORG AG BY IF,30600055,CDM,306,RC,87300,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INF AGENT MULTI ORG AG BY IF,30600055,CDM,306,RC,87300,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ADENOVIRUS AG EIA,30600056,CDM,306,RC,87301,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ADENOVIRUS AG EIA,30600056,CDM,306,RC,87301,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 2/8/2017 HC GALACTOMANNAN ASSAY,30600057,CDM,306,RC,87305,HCPCS,facility,both,,,,57.46,57.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASPERGILLUS AG EIA,30600059,CDM,306,RC,87305,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ASPERGILLUS AG EIA,30600059,CDM,306,RC,87305,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GIARDIA AG EIA,30600061,CDM,306,RC,87329,HCPCS,facility,both,,,,36.5,36.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GIARDIA AG EIA,30600061,CDM,306,RC,87329,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC E COLI 0157 AG EIA,30600062,CDM,306,RC,87335,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC E COLI 0157 AG EIA,30600062,CDM,306,RC,87335,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPYLORI STOOL EIA,30600063,CDM,306,RC,87338,HCPCS,facility,both,,,,14.38,14.38,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HPYLORI STOOL EIA,30600063,CDM,306,RC,87338,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPYLORI STOOL EIA,30600063,CDM,306,RC,87338,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,10.33,10.33,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION,30600065,CDM,306,RC,87341,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION,30600065,CDM,306,RC,87341,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION,30600065,CDM,306,RC,87341,HCPCS,facility,both,,,,10.33,10.33,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HEPATITIS BE AG EIA,30600066,CDM,306,RC,87350,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS BE AG EIA,30600066,CDM,306,RC,87350,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HISTOPLASMA CAPSUL AG EIA,30600067,CDM,306,RC,87385,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HISTOPLASMA CAPSUL AG EIA,30600067,CDM,306,RC,87385,HCPCS,facility,both,,,,105,105,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ROTAVIRUS AG EIA,30600068,CDM,306,RC,87425,HCPCS,facility,both,,,,93.5,93.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ROTAVIRUS AG EIA,30600068,CDM,306,RC,87425,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STREP A AG EIA,30600069,CDM,306,RC,87430,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STREP A AG EIA,30600069,CDM,306,RC,87430,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA BY EIA - MULTI STEP,30600070,CDM,306,RC,87449,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLAMYDIA T AMPLIF NA PROBE,30600071,CDM,306,RC,87491,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHLAMYDIA T AMPLIF NA PROBE,30600071,CDM,306,RC,87491,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHLAMYDIA T AMPLIF NA PROBE,30600071,CDM,306,RC,87491,HCPCS,facility,both,,,,35.09,35.09,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC C DIFF AMPLIFIED PROBE,30600072,CDM,306,RC,87493,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC C DIFF AMPLIFIED PROBE,30600072,CDM,306,RC,87493,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOMEGALOV AMPLIF NA PROBE,30600073,CDM,306,RC,87496,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOMEGALOV AMPLIF NA PROBE,30600073,CDM,306,RC,87496,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTOMEGALOVIRUS NA QUAN,30600074,CDM,306,RC,87497,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTOMEGALOVIRUS NA QUAN,30600074,CDM,306,RC,87497,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ENTEROVIRUS DNA AMP PROBE,30600075,CDM,306,RC,87498,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ENTEROVIRUS DNA AMP PROBE,30600075,CDM,306,RC,87498,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEP-B NA QUAN,30600076,CDM,306,RC,87517,HCPCS,facility,both,,,,255,255,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HEP-B NA QUAN,30600076,CDM,306,RC,87517,HCPCS,facility,both,,,,155,155,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEP-B NA QUAN,30600076,CDM,306,RC,87517,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEP-C AMPLIF NA PROBE,30600077,CDM,306,RC,87521,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEP-C AMPLIF NA PROBE,30600077,CDM,306,RC,87521,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HERPES S AMPLIF NA PROBE,30600078,CDM,306,RC,87529,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HERPES S AMPLIF NA PROBE,30600078,CDM,306,RC,87529,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HIV-1 AMPLIF NA PROBE,30600079,CDM,306,RC,87535,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HIV-1 AMPLIF NA PROBE,30600079,CDM,306,RC,87535,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEGIONELLA AMPLIF NA PROBE,30600080,CDM,306,RC,87541,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEGIONELLA AMPLIF NA PROBE,30600080,CDM,306,RC,87541,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYCOBACTERIA T DIR NA PROBE,30600081,CDM,306,RC,87555,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYCOBACTERIA T DIR NA PROBE,30600081,CDM,306,RC,87555,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MYCOBACTERIA T AMPLIF NA PROBE,30600082,CDM,306,RC,87556,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MYCOBACTERIA T AMPLIF NA PROBE,30600082,CDM,306,RC,87556,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NEISSERIA AMPLIF NA PROBE,30600083,CDM,306,RC,87591,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NEISSERIA AMPLIF NA PROBE,30600083,CDM,306,RC,87591,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MR-STAPH DNA AMP PROBE,30600084,CDM,306,RC,87641,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MR-STAPH DNA AMP PROBE,30600084,CDM,306,RC,87641,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TRICHOMONAS VAGIN DIR PROBE,30600085,CDM,306,RC,87660,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AMPLIF NA PROBE NOS AGENT,30600087,CDM,306,RC,87798,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AMPLIF NA PROBE NOS AGENT,30600087,CDM,306,RC,87798,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NA QUAN NOS AGENT,30600088,CDM,306,RC,87799,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NA QUAN NOS AGENT,30600088,CDM,306,RC,87799,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DNA/RNA; MULTI ORG - AMP PR,30600089,CDM,306,RC,87801,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA/RNA; MULTI ORG - AMP PR,30600089,CDM,306,RC,87801,HCPCS,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC AGENT NOS ASSAY W/OPTIC,30600090,CDM,306,RC,87899,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC AGENT NOS ASSAY W/OPTIC,30600090,CDM,306,RC,87899,HCPCS,facility,both,,,,60.5,60.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HIV REVERSE T,30600091,CDM,306,RC,87901,HCPCS,facility,both,,,,370,370,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HIV REVERSE T,30600091,CDM,306,RC,87901,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS C - DNA OR RNA,30600092,CDM,306,RC,87902,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEPATITIS C - DNA OR RNA,30600092,CDM,306,RC,87902,HCPCS,facility,both,,,,301,301,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HEPATITIS C - DNA OR RNA,30600092,CDM,306,RC,87902,HCPCS,facility,both,,,,257.45,257.45,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HEPATITIS C - DNA OR RNA,30600092,CDM,306,RC,87902,HCPCS,facility,both,,,,311,311,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PHENOTYPE DNA HIV W/CULTURE; 1-10 DRUGS,30600093,CDM,306,RC,87903,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IDENT BY DNA SEQUENCE,30600095,CDM,306,RC,87153,HCPCS,facility,both,,,,142.35,142.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IDENT BY DNA SEQUENCE,30600095,CDM,306,RC,87153,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CMV GENOTYPE,30600096,CDM,306,RC,87153,HCPCS,facility,both,,,,282.61,282.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV GENOTYPE,30600096,CDM,306,RC,87153,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEGIONELLA AG,30600097,CDM,306,RC,87449,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEGIONELLA AG,30600097,CDM,306,RC,87449,HCPCS,facility,both,,,,55.5,55.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STREP PNUMO AG,30600098,CDM,306,RC,87449,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STREP PNUMO AG,30600098,CDM,306,RC,87449,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CRYPT AG TITER,30600099,CDM,306,RC,87449,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CRYPT AG TITER,30600099,CDM,306,RC,87449,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOSTRIDIUM AG EIA,30600152,CDM,306,RC,87324,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CLOSTRIDIUM AG EIA,30600152,CDM,306,RC,87324,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INFLUENZA A/B AG EIA,30600155,CDM,306,RC,87400,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RESP SYNCYTIAL AG EIA,30600156,CDM,306,RC,87420,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INFLUENZA IA W DO,30600160,CDM,306,RC,87804,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INFLUENZA IA W DO,30600160,CDM,306,RC,87804,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENOTYPE IFECT AGENT DRUG (160),30600161,CDM,306,RC,87900,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MACROSCOPIC EXAM PARASITE,30600166,CDM,306,RC,87169,HCPCS,facility,both,,,,14.5,14.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MACROSCOPIC EXAM PARASITE,30600166,CDM,306,RC,87169,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NOS INFECTIOUS AG BY IF,30600168,CDM,306,RC,87299,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NOS INFECTIOUS AG BY IF,30600168,CDM,306,RC,87299,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BARTONELLA AMPLIF NAP,30600171,CDM,306,RC,87471,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEP-B AMPLIF NA PROBE,30600172,CDM,306,RC,87516,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEP-B AMPLIF NA PROBE,30600172,CDM,306,RC,87516,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HERPES S NA QUAN,30600173,CDM,306,RC,87530,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HERPES S NA QUAN,30600173,CDM,306,RC,87530,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MACROSCOPIC EXAM ARTHROPOD,30600176,CDM,306,RC,87168,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MACROSCOPIC EXAM ARTHROPOD,30600176,CDM,306,RC,87168,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SENSITIVITY - MYCOBACT EA AGNT,30600178,CDM,306,RC,87190,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SENSITIVITY - MYCOBACT EA AGNT,30600178,CDM,306,RC,87190,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOXIN ASSAY TISSUE CULTURE,30600179,CDM,306,RC,87230,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TOXIN ASSAY TISSUE CULTURE,30600179,CDM,306,RC,87230,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE
HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,24.08,24.08,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SHIGA-LIKE TOXIN AG EIA,30600183,CDM,306,RC,87427,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SHIGA-LIKE TOXIN AG EIA,30600183,CDM,306,RC,87427,HCPCS,facility,both,,,,17.3,17.3,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HERPES 6 NA QUAN,30600185,CDM,306,RC,87533,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HERPES 6 NA QUAN,30600185,CDM,306,RC,87533,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RESP VIRUS 6-11 TARGETS,30600189,CDM,306,RC,87632,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RESP VIRUS 6-11 TARGETS,30600189,CDM,306,RC,87632,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STREP B DNA AMP PROBE,30600191,CDM,306,RC,87653,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STREP B DNA AMP PROBE,30600191,CDM,306,RC,87653,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DIR NA PROBE MULTI ORGANISMS,30600192,CDM,306,RC,87800,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STREP A ASSAY W/OPTIC,30600196,CDM,306,RC,87880,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STREP A ASSAY W/OPTIC,30600196,CDM,306,RC,87880,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HEPATITIS B,30600198,CDM,306,RC,87912,HCPCS,facility,both,,,,211,211,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HEPATITIS B,30600198,CDM,306,RC,87912,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRICHOMONAS ASSAY W/OPTIC,30600199,CDM,306,RC,87808,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC HOMOGENIZATION, TISSUE, FOR CULTURE",30600200,CDM,306,RC,87176,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IA BY EIA-MULTISTEP (250,30600201,CDM,306,RC,87449,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RESP VIRUS 3-5 TARGETS,30600202,CDM,306,RC,87631,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RESP VIRUS 3-5 TARGETS,30600202,CDM,306,RC,87631,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HIV OTH REGION (180),30600203,CDM,306,RC,87906,HCPCS,facility,both,,,,360,360,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HIV OTH REGION (180),30600203,CDM,306,RC,87906,HCPCS,facility,both,,,,376.81,376.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  GENOTYPE DNA HIV OTH REGION (185),30600204,CDM,306,RC,87906,HCPCS,facility,both,,,,376.75,376.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HIV OTH REGION (185),30600204,CDM,306,RC,87906,HCPCS,facility,both,,,,387.29,387.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  GENOTYPE DNA HIV OTH REGION (260),30600205,CDM,306,RC,87906,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  GENOTYPE DNA HIV OTH REGION (260),30600205,CDM,306,RC,87906,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HIV OTH REGION (340),30600206,CDM,306,RC,87906,HCPCS,facility,both,,,,611,611,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HIV OTH REGION (340),30600206,CDM,306,RC,87906,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  GENOTYPE DNA HIV OTH REGION (490),30600207,CDM,306,RC,87906,HCPCS,facility,both,,,,870,870,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HIV OTH REGION (490),30600207,CDM,306,RC,87906,HCPCS,facility,both,,,,1025.79,1025.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  GENOTYPE DNA HIV OTH REGION (1430),30600208,CDM,306,RC,87906,HCPCS,facility,both,,,,2993.62,2993.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  GENOTYPE DNA HIV OTH REGION (1430),30600208,CDM,306,RC,87906,HCPCS,facility,both,,,,2845,2845,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC  GENOTYPE DNA HEPATITIS B (100),30600209,CDM,306,RC,87912,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENOTYPE HIV 1-5 ADDON,30600210,CDM,306,RC,87904,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC INFECT AGENT DET,GI 3-5 TARGET",30600211,CDM,306,RC,87505,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC INFECT AGENT DET,GI 3-5 TARGET",30600211,CDM,306,RC,87505,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA BY EIA-MULTISTEP (125),30600212,CDM,306,RC,87449,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IA BY EIA-MULTISTEP (125),30600212,CDM,306,RC,87449,HCPCS,facility,both,,,,261.68,261.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMEAR COMPLEX STAIN,30600213,CDM,306,RC,87209,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC INFEC AGENT DET,GI  6-11 TARGETS",30600214,CDM,306,RC,87506,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC INFEC AGENT DET,GI  6-11 TARGETS",30600214,CDM,306,RC,87506,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC INFEC AGENT DET,GI  12-25 TARGETS",30600215,CDM,306,RC,87507,HCPCS,facility,both,,,,376.81,376.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENOTYPE DNA HIV OTH REION (620),30600216,CDM,306,RC,87906,HCPCS,facility,both,,,,1088,1088,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HIV OTH REION (620),30600216,CDM,306,RC,87906,HCPCS,facility,both,,,,1297.93,1297.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  ZIKA VIRUS DNA/RNA AMP PROBE,30600217,CDM,306,RC,87662,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  ZIKA VIRUS DNA/RNA AMP PROBE,30600217,CDM,306,RC,87662,HCPCS,facility,both,,,,405,405,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STREP A AMPLIF NA PROBE,30600218,CDM,306,RC,87651,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STREP A AMPLIF NA PROBE,30600218,CDM,306,RC,87651,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CANDIDA NA AMPLIFIED PROBE,30600219,CDM,306,RC,87481,HCPCS,facility,both,,,,71,71,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CANDIDA NA AMPLIFIED PROBE,30600219,CDM,306,RC,87481,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENOTYPE INFECT AGENT DRUG (80),30600220,CDM,306,RC,87900,HCPCS,facility,both,,,,167.48,167.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENOTYPE DNA HIV OTHER REGION (75),30600221,CDM,306,RC,87906,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PHENOTYPE INFECT AGENT DRUG (1),30600222,CDM,306,RC,87900,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPV HIGH-RISK TYPES (275),30600223,CDM,306,RC,87624,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HIV-2 QUANT & REV TRANSCRIP,30600224,CDM,306,RC,87539,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DNA/RNA AMPLIFIED PROBE,30600225,CDM,306,RC,87150,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DNA/RNA AMPLIFIED PROBE,30600225,CDM,306,RC,87150,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HIV OTHER REGION (40),30600226,CDM,306,RC,87906,HCPCS,facility,both,,,,360,360,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GENOTYPE DNA HIV OTHER REGION (40),30600226,CDM,306,RC,87906,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RESP VIRUS 12-25 TARGETS,30600227,CDM,306,RC,87633,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RESP VIRUS 12-25 TARGETS,30600227,CDM,306,RC,87633,HCPCS,facility,both,,,,376.81,376.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL,30600228,CDM,306,RC,,,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL,30600228,CDM,306,RC,,,facility,both,,,,51.31,51.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CDC-CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL,30600229,CDM,306,RC,,,facility,both,,,,51.31,51.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 7/1/25 HC SARS-COV-2 (120),30600230,CDM,306,RC,87635,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
DEAC 7/1/25 HC SARS-COV-2 (120),30600230,CDM,306,RC,87635,HCPCS,facility,both,,,,47.97,47.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RSV DNA/RNA AMP PROBE (2),30600231,CDM,306,RC,87634,HCPCS,facility,both,,,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INFLUENZA DNA AMP PROBE,30600232,CDM,306,RC,87502,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC INFLUENZA DNA AMP PROBE,30600232,CDM,306,RC,87502,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SARSCOV CORONAVIRUS AG IA,30600233,CDM,306,RC,87426,HCPCS,facility,both,,,,33.49,33.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV,30600234,CDM,306,RC,87637,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV,30600234,CDM,306,RC,87637,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NFCT DS BV&VAGINITIS DNA ALG,30600235,CDM,306,RC,81514,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NFCT DS BV&VAGINITIS DNA ALG,30600235,CDM,306,RC,81514,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
DEAC 05/12/2023 HC COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT,30600236,CDM,306,RC,,,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC M. GENITALIUM AMP PROBE,30600237,CDM,306,RC,87563,HCPCS,facility,both,,,,94.2,94.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CUL TYP D BLD PTHGN 6+TRGT,30600238,CDM,306,RC,87154,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; ORTHOPOXVIRUS, AMPLIFIED PROBE TECHNIQUE, EA",30600239,CDM,306,RC,87593,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SARS-COV-2 (24),30600248,CDM,306,RC,87635,HCPCS,facility,both,,,,50.27,50.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SARSCOV2 &INF A&B & RSV (39),30600249,CDM,306,RC,87637,HCPCS,facility,both,,,,81.68,81.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MYCOBACTERIUM SP,DNA PROBE",30660015,CDM,306,RC,87551,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC RALTEGRAVIR RESISITANCE, HIV-1",30660018,CDM,306,RC,87906,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC INFECT DS (BACTERIAL/VIRAL), TRAIL IP-10 C-REACT PRTN SERUM (41)",30660055,CDM,306,RC,,,facility,both,,,,85.83,85.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  LAB OTHER,30900000,CDM,309,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LYMPHOCYTOTOX VC;  W TITRATE,30900001,CDM,310,RC,86805,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA TYPE; A B C MULTI AG,30900002,CDM,310,RC,86813,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HLA TYPE; DR/DQ MULTI AG,30900003,CDM,310,RC,86817,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HLA X-MATCH NON-CYTOTOXIC,30900004,CDM,302,RC,86825,HCPCS,facility,both,,,,925.29,925.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; LYMPHOCYTE,30900006,CDM,311,RC,88230,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; LYMPHOCYTE,30900006,CDM,311,RC,88230,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL,30900008,CDM,319,RC,88269,HCPCS,facility,both,,,,680,680,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL,30900008,CDM,319,RC,88269,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MCG; DNA PROBE EA,30900009,CDM,311,RC,88271,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MCG; DNA PROBE EA,30900009,CDM,311,RC,88271,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COLLECT SWEAT FOR TEST,30900010,CDM,300,RC,89230,HCPCS,facility,both,,,,24.5,24.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COLLECT SWEAT FOR TEST,30900010,CDM,300,RC,89230,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MPL W515 & S505 MUTATION,30900012,CDM,310,RC,81402,HCPCS,facility,both,,,,366.35,366.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MPL W515 & S505 MUTATION,30900012,CDM,310,RC,81402,HCPCS,facility,both,,,,357,357,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELIAC GENE TEST,30900013,CDM,310,RC,81382,HCPCS,facility,both,,,,94.37,94.37,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PML RARA,30900014,CDM,310,RC,81315,HCPCS,facility,both,,,,188.5,188.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PML RARA,30900014,CDM,310,RC,81315,HCPCS,facility,both,,,,577.79,577.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC JAK2 (V617F) MUTATION,30900015,CDM,310,RC,81270,HCPCS,facility,both,,,,410.32,410.32,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC JAK2 (V617F) MUTATION,30900015,CDM,310,RC,81270,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYSTIC FIBROSIS SCREEN,30900016,CDM,310,RC,81220,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (175),30900018,CDM,310,RC,81265,HCPCS,facility,both,,,,366.35,366.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE (115),30900019,CDM,310,RC,81275,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (130),30900020,CDM,310,RC,81401,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (395),30900021,CDM,310,RC,81401,HCPCS,facility,both,,,,826.9,826.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (260),30900022,CDM,310,RC,81403,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (260),30900022,CDM,310,RC,81403,HCPCS,facility,both,,,,495,495,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (435),30900023,CDM,310,RC,81404,HCPCS,facility,both,,,,910.64,910.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (300),30900024,CDM,310,RC,81404,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (570),30900025,CDM,310,RC,81405,HCPCS,facility,both,,,,1000,1000,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (570),30900025,CDM,310,RC,81405,HCPCS,facility,both,,,,1193.26,1193.26,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC APC GENE PART OF PANEL,30900026,CDM,310,RC,81201,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL MJR BP PART OF PANEL,30900027,CDM,310,RC,81206,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL OT BP PART OF PANEL,30900028,CDM,310,RC,81209,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BRCA PART OF PANEL,30900029,CDM,309,RC,81211,HCPCS,facility,both,,,,2,2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE COM VARIAN (50),30900030,CDM,310,RC,81220,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE COM VARIAN (190),30900031,CDM,310,RC,81220,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE COM VARIAN (300),30900032,CDM,310,RC,81220,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR DEL/DUP PART OF PANEL,30900033,CDM,310,RC,81222,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE FULL SEQUENCE (1250),30900034,CDM,310,RC,81223,HCPCS,facility,both,,,,2616.79,2616.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE FULL SEQUENCE (1630),30900035,CDM,310,RC,81223,HCPCS,facility,both,,,,3412.3,3412.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE INTRON POLY T (170),30900036,CDM,310,RC,81224,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN MCRARRAY COPY NMBR (860),30900037,CDM,310,RC,81228,HCPCS,facility,both,,,,1800.35,1800.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN MCRARRAY COPY NMBR (2000),30900038,CDM,310,RC,81228,HCPCS,facility,both,,,,5627,5627,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTOGEN MCRARRAY COPY NMBR (2000),30900038,CDM,310,RC,81228,HCPCS,facility,both,,,,4186.87,4186.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN M ARRAY COPY NO&SNP (640),30900039,CDM,310,RC,81229,HCPCS,facility,both,,,,1339.8,1339.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN M ARRAY COPY NO&SNP (640),30900039,CDM,310,RC,81229,HCPCS,facility,both,,,,1042,1042,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EGFR GENE   (220),30900040,CDM,310,RC,81235,HCPCS,facility,both,,,,460.55,460.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FANCC GENE  (70),30900041,CDM,310,RC,81242,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FANCC  GENE (140),30900042,CDM,310,RC,81242,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FMR1 GENE DETECTION (100),30900043,CDM,310,RC,81243,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FMR1 GENE DETECTION (225),30900044,CDM,310,RC,81243,HCPCS,facility,both,,,,471.02,471.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FMR1 GENE DETECTION (225),30900044,CDM,310,RC,81243,HCPCS,facility,both,,,,415,415,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FMR1 GENE CHARACTERIZ (20),30900045,CDM,310,RC,81244,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FMR1 GENE CHARACTERIZ (20),30900045,CDM,310,RC,81244,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE ( 410),30900046,CDM,310,RC,81245,HCPCS,facility,both,,,,862.5,862.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE PART OF PANEL),30900047,CDM,310,RC,81246,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GBA GENE (165),30900048,CDM,310,RC,81251,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGK GENE PART OF PANEL,30900049,CDM,310,RC,81264,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (200),30900050,CDM,310,RC,81265,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (200),30900050,CDM,310,RC,81265,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STR MARKERS SPECIMEN ANAL (230),30900051,CDM,310,RC,81265,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (315),30900052,CDM,310,RC,81265,HCPCS,facility,both,,,,659.44,659.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (985),30900053,CDM,310,RC,81265,HCPCS,facility,both,,,,2062.04,2062.04,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC JAK2 GENE (1020),30900054,CDM,310,RC,81270,HCPCS,facility,both,,,,2135.31,2135.31,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MLH1 GENE PART OF PANEL,30900055,CDM,310,RC,81292,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MSH2 GENE FULL SEQ  (2670),30900056,CDM,310,RC,81295,HCPCS,facility,both,,,,5589.48,5589.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MSH2 GENE FULL SEQ  (3310),30900057,CDM,310,RC,81295,HCPCS,facility,both,,,,6929.28,6929.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MSH6 GENE PART OF PANEL,30900058,CDM,310,RC,81298,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PCA3 (260),30900059,CDM,310,RC,81313,HCPCS,facility,both,,,,520,520,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PCA3 (260),30900059,CDM,310,RC,81313,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PML/RARA BP PART OF PANEL,30900060,CDM,310,RC,81315,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PTEN GENE PART OF PANEL,30900061,CDM,310,RC,81321,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMPP22 GENE DUP/DELET (1380),30900062,CDM,310,RC,81324,HCPCS,facility,both,,,,2888.94,2888.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMPP22 GENE DUP/DELET (4700),30900063,CDM,310,RC,81324,HCPCS,facility,both,,,,9839.15,9839.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 1 (65),30900064,CDM,310,RC,81400,HCPCS,facility,both,,,,136.07,136.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 1 (140),30900065,CDM,310,RC,81400,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 1 (205),30900066,CDM,310,RC,81400,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LVEL 1 (240),30900067,CDM,310,RC,81400,HCPCS,facility,both,,,,502.42,502.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LVEL 1 (240),30900067,CDM,310,RC,81400,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (95),30900068,CDM,310,RC,81401,HCPCS,facility,both,,,,198.87,198.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (150),30900069,CDM,310,RC,81401,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (150),30900069,CDM,310,RC,81401,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (170),30900070,CDM,310,RC,81401,HCPCS,facility,both,,,,345,345,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (170),30900070,CDM,310,RC,81401,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (190),30900071,CDM,310,RC,81401,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (195),30900072,CDM,310,RC,81401,HCPCS,facility,both,,,,408.22,408.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (195),30900072,CDM,310,RC,81401,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (200),30900073,CDM,310,RC,81401,HCPCS,facility,both,,,,375,375,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (200),30900073,CDM,310,RC,81401,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (205),30900074,CDM,310,RC,81401,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (205),30900074,CDM,310,RC,81401,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (215),30900075,CDM,310,RC,81401,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (215),30900075,CDM,310,RC,81401,HCPCS,facility,both,,,,450.09,450.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (220),30900076,CDM,310,RC,81401,HCPCS,facility,both,,,,460.55,460.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (225),30900077,CDM,310,RC,81401,HCPCS,facility,both,,,,471.02,471.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (250),30900078,CDM,310,RC,81401,HCPCS,facility,both,,,,275,275,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (250),30900078,CDM,310,RC,81401,HCPCS,facility,both,,,,523.36,523.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (265),30900079,CDM,310,RC,81401,HCPCS,facility,both,,,,554.76,554.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (275),30900080,CDM,310,RC,81401,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (290),30900081,CDM,310,RC,81401,HCPCS,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (290),30900081,CDM,310,RC,81401,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (300),30900082,CDM,310,RC,81401,HCPCS,facility,both,,,,435,435,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (300),30900082,CDM,310,RC,81401,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (310),30900083,CDM,310,RC,81401,HCPCS,facility,both,,,,648.96,648.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (315),30900084,CDM,310,RC,81401,HCPCS,facility,both,,,,659.44,659.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (320),30900085,CDM,310,RC,81401,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (320),30900085,CDM,310,RC,81401,HCPCS,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (380),30900086,CDM,310,RC,81401,HCPCS,facility,both,,,,755,755,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (380),30900086,CDM,310,RC,81401,HCPCS,facility,both,,,,795.51,795.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (400),30900087,CDM,310,RC,81401,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (780),30900088,CDM,310,RC,81401,HCPCS,facility,both,,,,1632.88,1632.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (835),30900089,CDM,310,RC,81401,HCPCS,facility,both,,,,1748.02,1748.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 3 (95),30900090,CDM,310,RC,81402,HCPCS,facility,both,,,,198.87,198.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 3 (95),30900090,CDM,310,RC,81402,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 3 (245),30900091,CDM,310,RC,81402,HCPCS,facility,both,,,,512.89,512.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 3 (245),30900091,CDM,310,RC,81402,HCPCS,facility,both,,,,420,420,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (115),30900092,CDM,310,RC,81403,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (130),30900093,CDM,310,RC,81403,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (130),30900093,CDM,310,RC,81403,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (135),30900094,CDM,310,RC,81403,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (135),30900094,CDM,310,RC,81403,HCPCS,facility,both,,,,282.61,282.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (145),30900095,CDM,310,RC,81403,HCPCS,facility,both,,,,303.55,303.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (145),30900095,CDM,310,RC,81403,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (165),30900096,CDM,310,RC,81403,HCPCS,facility,both,,,,345,345,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (165),30900096,CDM,310,RC,81403,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (180),30900097,CDM,310,RC,81403,HCPCS,facility,both,,,,376.81,376.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (180),30900097,CDM,310,RC,81403,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (190),30900098,CDM,310,RC,81403,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (210),30900099,CDM,310,RC,81403,HCPCS,facility,both,,,,439.62,439.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (210),30900099,CDM,310,RC,81403,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (220),30900100,CDM,310,RC,81403,HCPCS,facility,both,,,,460.55,460.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (220),30900100,CDM,310,RC,81403,HCPCS,facility,both,,,,515,515,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (255),30900101,CDM,310,RC,81403,HCPCS,facility,both,,,,533.83,533.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (280),30900102,CDM,310,RC,81403,HCPCS,facility,both,,,,586.16,586.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (325),30900103,CDM,310,RC,81403,HCPCS,facility,both,,,,680.37,680.37,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (330,30900104,CDM,310,RC,81403,HCPCS,facility,both,,,,690.83,690.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (330,30900104,CDM,310,RC,81403,HCPCS,facility,both,,,,500,500,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (335),30900105,CDM,310,RC,81403,HCPCS,facility,both,,,,701.3,701.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVE 4 (345),30900106,CDM,310,RC,81403,HCPCS,facility,both,,,,722.23,722.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (405),30900107,CDM,310,RC,81403,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (435),30900108,CDM,310,RC,81403,HCPCS,facility,both,,,,910.64,910.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (455),30900109,CDM,310,RC,81403,HCPCS,facility,both,,,,952.51,952.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (500),30900110,CDM,310,RC,81403,HCPCS,facility,both,,,,1046.72,1046.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (530),30900111,CDM,310,RC,81403,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (530),30900111,CDM,310,RC,81403,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (540),30900112,CDM,310,RC,81403,HCPCS,facility,both,,,,1130.45,1130.45,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (540),30900112,CDM,310,RC,81403,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (590),30900113,CDM,310,RC,81403,HCPCS,facility,both,,,,1235.13,1235.13,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (655),30900114,CDM,310,RC,81403,HCPCS,facility,both,,,,1371.21,1371.21,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (655),30900114,CDM,310,RC,81403,HCPCS,facility,both,,,,2165,2165,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (690),30900115,CDM,310,RC,81403,HCPCS,facility,both,,,,1444.47,1444.47,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (810),30900116,CDM,310,RC,81403,HCPCS,facility,both,,,,1695.69,1695.69,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (810),30900116,CDM,310,RC,81403,HCPCS,facility,both,,,,540,540,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (2070),30900117,CDM,310,RC,81403,HCPCS,facility,both,,,,4333.42,4333.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (3400),30900118,CDM,310,RC,81403,HCPCS,facility,both,,,,7117.69,7117.69,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (290),30900119,CDM,310,RC,81404,HCPCS,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (290),30900119,CDM,310,RC,81404,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (305),30900120,CDM,310,RC,81404,HCPCS,facility,both,,,,648.96,648.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (325),30900121,CDM,310,RC,81404,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (325),30900121,CDM,310,RC,81404,HCPCS,facility,both,,,,680.37,680.37,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (335),30900122,CDM,310,RC,81404,HCPCS,facility,both,,,,701.3,701.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (360),30900123,CDM,310,RC,81404,HCPCS,facility,both,,,,753.64,753.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (360),30900123,CDM,310,RC,81404,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (370),30900124,CDM,310,RC,81404,HCPCS,facility,both,,,,774.57,774.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (380),30900125,CDM,310,RC,81404,HCPCS,facility,both,,,,795.51,795.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (380),30900125,CDM,310,RC,81404,HCPCS,facility,both,,,,675,675,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (395),30900126,CDM,310,RC,81404,HCPCS,facility,both,,,,826.9,826.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (400),30900127,CDM,310,RC,81404,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (405),30900128,CDM,310,RC,81404,HCPCS,facility,both,,,,765,765,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (405),30900128,CDM,310,RC,81404,HCPCS,facility,both,,,,847.84,847.84,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (440),30900129,CDM,310,RC,81404,HCPCS,facility,both,,,,765,765,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (440),30900129,CDM,310,RC,81404,HCPCS,facility,both,,,,921.12,921.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (450),30900130,CDM,310,RC,81404,HCPCS,facility,both,,,,942.05,942.05,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (450),30900130,CDM,310,RC,81404,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (480),30900131,CDM,310,RC,81404,HCPCS,facility,both,,,,515,515,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (480),30900131,CDM,310,RC,81404,HCPCS,facility,both,,,,1004.85,1004.85,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (500),30900132,CDM,310,RC,81404,HCPCS,facility,both,,,,1046.72,1046.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (500),30900132,CDM,310,RC,81404,HCPCS,facility,both,,,,640,640,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (535),30900133,CDM,310,RC,81404,HCPCS,facility,both,,,,1100,1100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (535),30900133,CDM,310,RC,81404,HCPCS,facility,both,,,,1119.99,1119.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (735),30900134,CDM,310,RC,81404,HCPCS,facility,both,,,,1375,1375,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 5 (735),30900134,CDM,310,RC,81404,HCPCS,facility,both,,,,1538.67,1538.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (1180),30900135,CDM,310,RC,81404,HCPCS,facility,both,,,,2470.25,2470.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (2440),30900136,CDM,310,RC,81404,HCPCS,facility,both,,,,5107.99,5107.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (130),30900137,CDM,310,RC,81405,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (130),30900137,CDM,310,RC,81405,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (140),30900138,CDM,310,RC,81405,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (140),30900138,CDM,310,RC,81405,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (190),30900139,CDM,310,RC,81405,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (190),30900139,CDM,310,RC,81405,HCPCS,facility,both,,,,395,395,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (200),30900140,CDM,310,RC,81405,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (215),30900141,CDM,310,RC,81405,HCPCS,facility,both,,,,450.09,450.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (215),30900141,CDM,310,RC,81405,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (240),30900142,CDM,310,RC,81405,HCPCS,facility,both,,,,502.42,502.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (275),30900143,CDM,310,RC,81405,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (275),30900143,CDM,310,RC,81405,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (305),30900144,CDM,310,RC,81405,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (305),30900144,CDM,310,RC,81405,HCPCS,facility,both,,,,638.5,638.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (310),30900145,CDM,310,RC,81405,HCPCS,facility,both,,,,648.96,648.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (310),30900145,CDM,310,RC,81405,HCPCS,facility,both,,,,644,644,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (350),30900146,CDM,310,RC,81405,HCPCS,facility,both,,,,669,669,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (350),30900146,CDM,310,RC,81405,HCPCS,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (360),30900147,CDM,310,RC,81405,HCPCS,facility,both,,,,753.64,753.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (360),30900147,CDM,310,RC,81405,HCPCS,facility,both,,,,740,740,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (455),30900148,CDM,310,RC,81405,HCPCS,facility,both,,,,952.51,952.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (460),30900149,CDM,310,RC,81405,HCPCS,facility,both,,,,962.98,962.98,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (515),30900150,CDM,310,RC,81405,HCPCS,facility,both,,,,1078.12,1078.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (515),30900150,CDM,310,RC,81405,HCPCS,facility,both,,,,725,725,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (530),30900151,CDM,310,RC,81405,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (530),30900151,CDM,310,RC,81405,HCPCS,facility,both,,,,1045,1045,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (540),30900152,CDM,310,RC,81405,HCPCS,facility,both,,,,1130.45,1130.45,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (540),30900152,CDM,310,RC,81405,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (630),30900153,CDM,310,RC,81405,HCPCS,facility,both,,,,800,800,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (630),30900153,CDM,310,RC,81405,HCPCS,facility,both,,,,1318.86,1318.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (640),30900154,CDM,310,RC,81405,HCPCS,facility,both,,,,1035,1035,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (640),30900154,CDM,310,RC,81405,HCPCS,facility,both,,,,1339.8,1339.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (660),30900155,CDM,310,RC,81405,HCPCS,facility,both,,,,1381.67,1381.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (685),30900156,CDM,310,RC,81405,HCPCS,facility,both,,,,1434,1434,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (685),30900156,CDM,310,RC,81405,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (705),30900157,CDM,310,RC,81405,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (705),30900157,CDM,310,RC,81405,HCPCS,facility,both,,,,1475.87,1475.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (725),30900158,CDM,310,RC,81405,HCPCS,facility,both,,,,1517.74,1517.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (750),30900159,CDM,310,RC,81405,HCPCS,facility,both,,,,1570.08,1570.08,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (750),30900159,CDM,310,RC,81405,HCPCS,facility,both,,,,1445,1445,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (800),30900160,CDM,310,RC,81405,HCPCS,facility,both,,,,1674.75,1674.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (1030),30900161,CDM,310,RC,81405,HCPCS,facility,both,,,,2730,2730,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 6 (1030),30900161,CDM,310,RC,81405,HCPCS,facility,both,,,,2156.24,2156.24,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (2660),30900162,CDM,310,RC,81405,HCPCS,facility,both,,,,5568.54,5568.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (105),30900163,CDM,310,RC,81406,HCPCS,facility,both,,,,219.81,219.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (130),30900164,CDM,310,RC,81406,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (130),30900164,CDM,310,RC,81406,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (140),30900165,CDM,310,RC,81406,HCPCS,facility,both,,,,225,225,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (140),30900165,CDM,310,RC,81406,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (200),30900166,CDM,310,RC,81406,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (205),30900167,CDM,310,RC,81406,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (205),30900167,CDM,310,RC,81406,HCPCS,facility,both,,,,395,395,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (215),30900168,CDM,310,RC,81406,HCPCS,facility,both,,,,450.09,450.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (215),30900168,CDM,310,RC,81406,HCPCS,facility,both,,,,445,445,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (240),30900169,CDM,310,RC,81406,HCPCS,facility,both,,,,502.42,502.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (240),30900169,CDM,310,RC,81406,HCPCS,facility,both,,,,495,495,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (260),30900170,CDM,310,RC,81406,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (260),30900170,CDM,310,RC,81406,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (305),30900171,CDM,310,RC,81406,HCPCS,facility,both,,,,638.5,638.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (305),30900171,CDM,310,RC,81406,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (315),30900172,CDM,310,RC,81406,HCPCS,facility,both,,,,645,645,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (315),30900172,CDM,310,RC,81406,HCPCS,facility,both,,,,659.44,659.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (415),30900173,CDM,310,RC,81406,HCPCS,facility,both,,,,868.77,868.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (500),30900174,CDM,310,RC,81406,HCPCS,facility,both,,,,1046.72,1046.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (500),30900174,CDM,310,RC,81406,HCPCS,facility,both,,,,640,640,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (540),30900175,CDM,310,RC,81406,HCPCS,facility,both,,,,650,650,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (540),30900175,CDM,310,RC,81406,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (530),30900176,CDM,310,RC,81406,HCPCS,facility,both,,,,890,890,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (530),30900176,CDM,310,RC,81406,HCPCS,facility,both,,,,1130.45,1130.45,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (615),30900177,CDM,310,RC,81406,HCPCS,facility,both,,,,1287.47,1287.47,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (625),30900178,CDM,310,RC,81406,HCPCS,facility,both,,,,1308.4,1308.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (630),30900179,CDM,310,RC,81406,HCPCS,facility,both,,,,1318.86,1318.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (630),30900179,CDM,310,RC,81406,HCPCS,facility,both,,,,800,800,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (640),30900180,CDM,310,RC,81406,HCPCS,facility,both,,,,715,715,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (640),30900180,CDM,310,RC,81406,HCPCS,facility,both,,,,1339.8,1339.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (655),30900181,CDM,310,RC,81406,HCPCS,facility,both,,,,1371.21,1371.21,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (655),30900181,CDM,310,RC,81406,HCPCS,facility,both,,,,1265,1265,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (670),30900182,CDM,310,RC,81406,HCPCS,facility,both,,,,1402.6,1402.6,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (670),30900182,CDM,310,RC,81406,HCPCS,facility,both,,,,1025,1025,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (685),30900183,CDM,310,RC,81406,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (685),30900183,CDM,310,RC,81406,HCPCS,facility,both,,,,1434,1434,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (715),30900184,CDM,310,RC,81406,HCPCS,facility,both,,,,1371,1371,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (715),30900184,CDM,310,RC,81406,HCPCS,facility,both,,,,1496.8,1496.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (725),30900185,CDM,310,RC,81406,HCPCS,facility,both,,,,1517.74,1517.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (735),30900186,CDM,310,RC,81406,HCPCS,facility,both,,,,1025,1025,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (735),30900186,CDM,310,RC,81406,HCPCS,facility,both,,,,1538.67,1538.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (800),30900187,CDM,310,RC,81406,HCPCS,facility,both,,,,1674.75,1674.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (800),30900187,CDM,310,RC,81406,HCPCS,facility,both,,,,975,975,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (830),30900188,CDM,310,RC,81406,HCPCS,facility,both,,,,1737.56,1737.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (985),30900189,CDM,310,RC,81406,HCPCS,facility,both,,,,2062.04,2062.04,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (985),30900189,CDM,310,RC,81406,HCPCS,facility,both,,,,1610,1610,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (1100),30900190,CDM,310,RC,81406,HCPCS,facility,both,,,,2045,2045,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (1100),30900190,CDM,310,RC,81406,HCPCS,facility,both,,,,2302.78,2302.78,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (1130),30900191,CDM,310,RC,81406,HCPCS,facility,both,,,,2365.59,2365.59,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (1180),30900192,CDM,310,RC,81406,HCPCS,facility,both,,,,2470.25,2470.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (1400),30900193,CDM,310,RC,81406,HCPCS,facility,both,,,,2930.81,2930.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 7 (1400),30900193,CDM,310,RC,81406,HCPCS,facility,both,,,,1920,1920,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (1640),30900194,CDM,310,RC,81406,HCPCS,facility,both,,,,2655,2655,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 7 (1640),30900194,CDM,310,RC,81406,HCPCS,facility,both,,,,3433.24,3433.24,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (165),30900195,CDM,310,RC,81407,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (165),30900195,CDM,310,RC,81407,HCPCS,facility,both,,,,301,301,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (710),30900196,CDM,310,RC,81407,HCPCS,facility,both,,,,1486.34,1486.34,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (710),30900196,CDM,310,RC,81407,HCPCS,facility,both,,,,1360,1360,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (790),30900197,CDM,310,RC,81407,HCPCS,facility,both,,,,1653.82,1653.82,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (790),30900197,CDM,310,RC,81407,HCPCS,facility,both,,,,1350,1350,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (890),30900198,CDM,310,RC,81407,HCPCS,facility,both,,,,1820,1820,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (890),30900198,CDM,310,RC,81407,HCPCS,facility,both,,,,1863.16,1863.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (1000),30900199,CDM,310,RC,81407,HCPCS,facility,both,,,,2093.44,2093.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (1000),30900199,CDM,310,RC,81407,HCPCS,facility,both,,,,1500,1500,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (1140),30900200,CDM,310,RC,81407,HCPCS,facility,both,,,,1725,1725,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (1140),30900200,CDM,310,RC,81407,HCPCS,facility,both,,,,2386.52,2386.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (875),30900201,CDM,310,RC,81407,HCPCS,facility,both,,,,1685,1685,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (875),30900201,CDM,310,RC,81407,HCPCS,facility,both,,,,1831.76,1831.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (1565),30900202,CDM,310,RC,81407,HCPCS,facility,both,,,,3265.76,3265.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (1625),30900203,CDM,310,RC,81407,HCPCS,facility,both,,,,3391.37,3391.37,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (1830),30900204,CDM,310,RC,81407,HCPCS,facility,both,,,,3830.99,3830.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (1830),30900204,CDM,310,RC,81407,HCPCS,facility,both,,,,2770,2770,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (2000),30900205,CDM,310,RC,81407,HCPCS,facility,both,,,,38.5,38.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 8 (2000),30900205,CDM,310,RC,81407,HCPCS,facility,both,,,,4186.87,4186.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 8 (3430),30900206,CDM,310,RC,81407,HCPCS,facility,both,,,,7180.49,7180.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (930),30900207,CDM,310,RC,81408,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 9 (930),30900207,CDM,310,RC,81408,HCPCS,facility,both,,,,1946.89,1946.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (935),30900208,CDM,310,RC,81408,HCPCS,facility,both,,,,1915,1915,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 9 (935),30900208,CDM,310,RC,81408,HCPCS,facility,both,,,,1957.37,1957.37,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (970),30900209,CDM,310,RC,81408,HCPCS,facility,both,,,,2030.63,2030.63,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (975),30900210,CDM,310,RC,81408,HCPCS,facility,both,,,,1995,1995,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 9 (975),30900210,CDM,310,RC,81408,HCPCS,facility,both,,,,2041.11,2041.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1050),30900211,CDM,310,RC,81408,HCPCS,facility,both,,,,2198.11,2198.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1080),30900212,CDM,310,RC,81408,HCPCS,facility,both,,,,2260.91,2260.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1170),30900213,CDM,310,RC,81408,HCPCS,facility,both,,,,2449.32,2449.32,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1170),30900213,CDM,310,RC,81408,HCPCS,facility,both,,,,2395,2395,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 9 (1240),30900214,CDM,310,RC,81408,HCPCS,facility,both,,,,2115,2115,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 9 (1240),30900214,CDM,310,RC,81408,HCPCS,facility,both,,,,2595.86,2595.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1295),30900215,CDM,310,RC,81408,HCPCS,facility,both,,,,2700.53,2700.53,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1390),30900216,CDM,310,RC,81408,HCPCS,facility,both,,,,2909.88,2909.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1390),30900216,CDM,310,RC,81408,HCPCS,facility,both,,,,2365,2365,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 9 (3405),30900217,CDM,310,RC,81408,HCPCS,facility,both,,,,7117.69,7117.69,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL CHRMOML ANEUPLOIDY (390),30900218,CDM,310,RC,81420,HCPCS,facility,both,,,,816.44,816.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL CHRMOML ANEUPLOIDY (390),30900218,CDM,310,RC,81420,HCPCS,facility,both,,,,615,615,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYS (1150),30900219,CDM,310,RC,81450,HCPCS,facility,both,,,,2407.46,2407.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYS (1150),30900219,CDM,310,RC,81450,HCPCS,facility,both,,,,1920,1920,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (115),30900220,CDM,310,RC,81479,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (115),30900220,CDM,310,RC,81479,HCPCS,facility,both,,,,245,245,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (120),30900221,CDM,310,RC,81479,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (130),30900222,CDM,310,RC,81479,HCPCS,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (130),30900222,CDM,310,RC,81479,HCPCS,facility,both,,,,272.15,272.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (135),30900223,CDM,310,RC,81479,HCPCS,facility,both,,,,451,451,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (135),30900223,CDM,310,RC,81479,HCPCS,facility,both,,,,282.61,282.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (160),30900224,CDM,310,RC,81479,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (160),30900224,CDM,310,RC,81479,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (185),30900225,CDM,310,RC,81479,HCPCS,facility,both,,,,425,425,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (185),30900225,CDM,310,RC,81479,HCPCS,facility,both,,,,387.29,387.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (200),30900226,CDM,310,RC,81479,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (200),30900226,CDM,310,RC,81479,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (205),30900227,CDM,310,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (205),30900227,CDM,310,RC,81479,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (210),30900228,CDM,310,RC,81479,HCPCS,facility,both,,,,439.62,439.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (210),30900228,CDM,310,RC,81479,HCPCS,facility,both,,,,395,395,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (220),30900229,CDM,310,RC,81479,HCPCS,facility,both,,,,460.55,460.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (220),30900229,CDM,310,RC,81479,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (240),30900230,CDM,310,RC,81479,HCPCS,facility,both,,,,397,397,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (240),30900230,CDM,310,RC,81479,HCPCS,facility,both,,,,502.42,502.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (250),30900231,CDM,310,RC,81479,HCPCS,facility,both,,,,375,375,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (250),30900231,CDM,310,RC,81479,HCPCS,facility,both,,,,523.36,523.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (255),30900232,CDM,310,RC,81479,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (255),30900232,CDM,310,RC,81479,HCPCS,facility,both,,,,533.83,533.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (260),30900233,CDM,310,RC,81479,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (260),30900233,CDM,310,RC,81479,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (280),30900234,CDM,310,RC,81479,HCPCS,facility,both,,,,560,560,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (280),30900234,CDM,310,RC,81479,HCPCS,facility,both,,,,586.16,586.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (290),30900235,CDM,310,RC,81479,HCPCS,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (290),30900235,CDM,310,RC,81479,HCPCS,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (295),30900236,CDM,310,RC,81479,HCPCS,facility,both,,,,617.57,617.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (295),30900236,CDM,310,RC,81479,HCPCS,facility,both,,,,580,580,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (310),30900237,CDM,310,RC,81479,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (310),30900237,CDM,310,RC,81479,HCPCS,facility,both,,,,648.96,648.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (315),30900238,CDM,310,RC,81479,HCPCS,facility,both,,,,659.44,659.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (330),30900239,CDM,310,RC,81479,HCPCS,facility,both,,,,690.83,690.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (330),30900239,CDM,310,RC,81479,HCPCS,facility,both,,,,475,475,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (345),30900240,CDM,310,RC,81479,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (345),30900240,CDM,310,RC,81479,HCPCS,facility,both,,,,722.23,722.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (350),30900241,CDM,310,RC,81479,HCPCS,facility,both,,,,675,675,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (350),30900241,CDM,310,RC,81479,HCPCS,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (385),30900242,CDM,310,RC,81479,HCPCS,facility,both,,,,805.97,805.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (395),30900243,CDM,310,RC,81479,HCPCS,facility,both,,,,644,644,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (395),30900243,CDM,310,RC,81479,HCPCS,facility,both,,,,826.9,826.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (435),30900244,CDM,310,RC,81479,HCPCS,facility,both,,,,910.64,910.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (440),30900245,CDM,310,RC,81479,HCPCS,facility,both,,,,921.12,921.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (440),30900245,CDM,310,RC,81479,HCPCS,facility,both,,,,785,785,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (455),30900246,CDM,310,RC,81479,HCPCS,facility,both,,,,952.51,952.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (460),30900247,CDM,310,RC,81479,HCPCS,facility,both,,,,962.98,962.98,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (465),30900248,CDM,310,RC,81479,HCPCS,facility,both,,,,973.45,973.45,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (465),30900248,CDM,310,RC,81479,HCPCS,facility,both,,,,815,815,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (470),30900249,CDM,310,RC,81479,HCPCS,facility,both,,,,983.92,983.92,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (470),30900249,CDM,310,RC,81479,HCPCS,facility,both,,,,625,625,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (480),30900250,CDM,310,RC,81479,HCPCS,facility,both,,,,1004.85,1004.85,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (480),30900250,CDM,310,RC,81479,HCPCS,facility,both,,,,798,798,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (485),30900251,CDM,310,RC,81479,HCPCS,facility,both,,,,1015.32,1015.32,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (500),30900252,CDM,310,RC,81479,HCPCS,facility,both,,,,1046.72,1046.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (500),30900252,CDM,310,RC,81479,HCPCS,facility,both,,,,770,770,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (510),30900253,CDM,310,RC,81479,HCPCS,facility,both,,,,1067.65,1067.65,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (510),30900253,CDM,310,RC,81479,HCPCS,facility,both,,,,770,770,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (520),30900254,CDM,310,RC,81479,HCPCS,facility,both,,,,1088.58,1088.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (530),30900255,CDM,310,RC,81479,HCPCS,facility,both,,,,930,930,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (530),30900255,CDM,310,RC,81479,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (570),30900256,CDM,310,RC,81479,HCPCS,facility,both,,,,1193.26,1193.26,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (575),30900257,CDM,310,RC,81479,HCPCS,facility,both,,,,1203.73,1203.73,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (575),30900257,CDM,310,RC,81479,HCPCS,facility,both,,,,933,933,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (585),30900258,CDM,310,RC,81479,HCPCS,facility,both,,,,1224.66,1224.66,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (600),30900259,CDM,310,RC,81479,HCPCS,facility,both,,,,1256.06,1256.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (600),30900259,CDM,310,RC,81479,HCPCS,facility,both,,,,1070,1070,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (640),30900260,CDM,310,RC,81479,HCPCS,facility,both,,,,890,890,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (640),30900260,CDM,310,RC,81479,HCPCS,facility,both,,,,1339.8,1339.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (645),30900261,CDM,310,RC,81479,HCPCS,facility,both,,,,1245,1245,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (645),30900261,CDM,310,RC,81479,HCPCS,facility,both,,,,1350.27,1350.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (660),30900262,CDM,310,RC,81479,HCPCS,facility,both,,,,1455,1455,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (660),30900262,CDM,310,RC,81479,HCPCS,facility,both,,,,1381.67,1381.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (670),30900263,CDM,310,RC,81479,HCPCS,facility,both,,,,1402.6,1402.6,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (680),30900264,CDM,310,RC,81479,HCPCS,facility,both,,,,1423.54,1423.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (670),30900265,CDM,310,RC,81479,HCPCS,facility,both,,,,1442.38,1442.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (670),30900265,CDM,310,RC,81479,HCPCS,facility,both,,,,1190,1190,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (715),30900266,CDM,310,RC,81479,HCPCS,facility,both,,,,1345,1345,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (715),30900266,CDM,310,RC,81479,HCPCS,facility,both,,,,1496.8,1496.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (725),30900267,CDM,310,RC,81479,HCPCS,facility,both,,,,1517.74,1517.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (725),30900267,CDM,310,RC,81479,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (730),30900268,CDM,310,RC,81479,HCPCS,facility,both,,,,795,795,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (730),30900268,CDM,310,RC,81479,HCPCS,facility,both,,,,1528.21,1528.21,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (750),30900269,CDM,310,RC,81479,HCPCS,facility,both,,,,1570.08,1570.08,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (780),30900270,CDM,310,RC,81479,HCPCS,facility,both,,,,1632.88,1632.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (780),30900270,CDM,310,RC,81479,HCPCS,facility,both,,,,1455,1455,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (785),30900271,CDM,310,RC,81479,HCPCS,facility,both,,,,1643.35,1643.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (800),30900272,CDM,310,RC,81479,HCPCS,facility,both,,,,1674.75,1674.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (800),30900272,CDM,310,RC,81479,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (825),30900273,CDM,310,RC,81479,HCPCS,facility,both,,,,1727.09,1727.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (825),30900273,CDM,310,RC,81479,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (835),30900274,CDM,310,RC,81479,HCPCS,facility,both,,,,1748.02,1748.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (925),30900275,CDM,310,RC,81479,HCPCS,facility,both,,,,1936.43,1936.43,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (925),30900275,CDM,310,RC,81479,HCPCS,facility,both,,,,1780,1780,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (955),30900276,CDM,310,RC,81479,HCPCS,facility,both,,,,1580,1580,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (955),30900276,CDM,310,RC,81479,HCPCS,facility,both,,,,1999.24,1999.24,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1000),30900277,CDM,310,RC,81479,HCPCS,facility,both,,,,2093.44,2093.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1000),30900277,CDM,310,RC,81479,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1030),30900278,CDM,310,RC,81479,HCPCS,facility,both,,,,2190,2190,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1030),30900278,CDM,310,RC,81479,HCPCS,facility,both,,,,2156.24,2156.24,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1050),30900279,CDM,310,RC,81479,HCPCS,facility,both,,,,2198.11,2198.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1050),30900279,CDM,310,RC,81479,HCPCS,facility,both,,,,1175,1175,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1070),30900280,CDM,310,RC,81479,HCPCS,facility,both,,,,2239.98,2239.98,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1070),30900280,CDM,310,RC,81479,HCPCS,facility,both,,,,1840,1840,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1080),30900281,CDM,310,RC,81479,HCPCS,facility,both,,,,2025,2025,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1080),30900281,CDM,310,RC,81479,HCPCS,facility,both,,,,2260.91,2260.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1100),30900282,CDM,310,RC,81479,HCPCS,facility,both,,,,1870,1870,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1100),30900282,CDM,310,RC,81479,HCPCS,facility,both,,,,2302.78,2302.78,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1150),30900283,CDM,310,RC,81479,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1150),30900283,CDM,310,RC,81479,HCPCS,facility,both,,,,2407.46,2407.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1190),30900284,CDM,310,RC,81479,HCPCS,facility,both,,,,1995,1995,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1190),30900284,CDM,310,RC,81479,HCPCS,facility,both,,,,2491.19,2491.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1380),30900285,CDM,310,RC,81479,HCPCS,facility,both,,,,2888.94,2888.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1380),30900285,CDM,310,RC,81479,HCPCS,facility,both,,,,2784,2784,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1460),30900286,CDM,310,RC,81479,HCPCS,facility,both,,,,3056.42,3056.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1500),30900287,CDM,310,RC,81479,HCPCS,facility,both,,,,3140.16,3140.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1500),30900287,CDM,310,RC,81479,HCPCS,facility,both,,,,2545,2545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1540),30900288,CDM,310,RC,81479,HCPCS,facility,both,,,,3223.89,3223.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1540),30900288,CDM,310,RC,81479,HCPCS,facility,both,,,,2700,2700,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1570),30900289,CDM,310,RC,81479,HCPCS,facility,both,,,,3286.69,3286.69,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1600),30900290,CDM,310,RC,81479,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1600),30900290,CDM,310,RC,81479,HCPCS,facility,both,,,,3349.5,3349.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1700),30900291,CDM,310,RC,81479,HCPCS,facility,both,,,,3558.84,3558.84,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1770),30900292,CDM,310,RC,81479,HCPCS,facility,both,,,,3705.39,3705.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1770),30900292,CDM,310,RC,81479,HCPCS,facility,both,,,,3245,3245,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1840),30900293,CDM,310,RC,81479,HCPCS,facility,both,,,,3206,3206,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1840),30900293,CDM,310,RC,81479,HCPCS,facility,both,,,,3851.92,3851.92,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1870),30900294,CDM,310,RC,81479,HCPCS,facility,both,,,,3914.72,3914.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1870),30900294,CDM,310,RC,81479,HCPCS,facility,both,,,,754,754,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1890),30900295,CDM,310,RC,81479,HCPCS,facility,both,,,,3956.59,3956.59,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1920),30900296,CDM,310,RC,81479,HCPCS,facility,both,,,,4019.4,4019.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1970),30900297,CDM,310,RC,81479,HCPCS,facility,both,,,,4124.07,4124.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1970),30900297,CDM,310,RC,81479,HCPCS,facility,both,,,,4340,4340,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (1980),30900298,CDM,310,RC,81479,HCPCS,facility,both,,,,4145,4145,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1980),30900298,CDM,310,RC,81479,HCPCS,facility,both,,,,5005,5005,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (2050),30900299,CDM,310,RC,81479,HCPCS,facility,both,,,,4291.55,4291.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2050),30900299,CDM,310,RC,81479,HCPCS,facility,both,,,,3050,3050,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (2070),30900300,CDM,310,RC,81479,HCPCS,facility,both,,,,4333.42,4333.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (1210),30900301,CDM,310,RC,81479,HCPCS,facility,both,,,,2533.06,2533.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2150),30900302,CDM,310,RC,81479,HCPCS,facility,both,,,,4500.89,4500.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2230),30900303,CDM,310,RC,81479,HCPCS,facility,both,,,,4668.36,4668.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2400),30900304,CDM,310,RC,81479,HCPCS,facility,both,,,,5024.25,5024.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2420),30900305,CDM,310,RC,81479,HCPCS,facility,both,,,,5066.12,5066.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2420),30900305,CDM,310,RC,81479,HCPCS,facility,both,,,,4490,4490,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (2710),30900306,CDM,310,RC,81479,HCPCS,facility,both,,,,5673.22,5673.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2800),30900307,CDM,310,RC,81479,HCPCS,facility,both,,,,5861.63,5861.63,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2800),30900307,CDM,310,RC,81479,HCPCS,facility,both,,,,5392,5392,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (4400),30900308,CDM,310,RC,81479,HCPCS,facility,both,,,,9211.12,9211.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (4880),30900309,CDM,310,RC,81479,HCPCS,facility,both,,,,10215.97,10215.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (4880),30900309,CDM,310,RC,81479,HCPCS,facility,both,,,,10000,10000,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (6000),30900310,CDM,310,RC,81479,HCPCS,facility,both,,,,11210,11210,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (6000),30900310,CDM,310,RC,81479,HCPCS,facility,both,,,,12560.62,12560.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ONCOLOGY BREAST MRNA (24500,30900311,CDM,310,RC,81519,HCPCS,facility,both,,,,5128.92,5128.92,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (1630),30900312,CDM,310,RC,81479,HCPCS,facility,both,,,,3412.3,3412.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 1 (650),30900313,CDM,310,RC,81400,HCPCS,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 1 (650),30900313,CDM,310,RC,81400,HCPCS,facility,both,,,,1360.73,1360.73,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FETAL CHROMOSOMAL ANEUPLOIDY (990),30900314,CDM,310,RC,81420,HCPCS,facility,both,,,,1652,1652,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FETAL CHROMOSOMAL ANEUPLOIDY (990),30900314,CDM,310,RC,81420,HCPCS,facility,both,,,,2072.5,2072.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (1000),30900315,CDM,310,RC,81455,HCPCS,facility,both,,,,1673,1673,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS (1000),30900315,CDM,310,RC,81455,HCPCS,facility,both,,,,2093.44,2093.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  TARGETED GEN SEQ 5-50 (460),30900316,CDM,310,RC,81445,HCPCS,facility,both,,,,962.98,962.98,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GEN SEQ 5-50 (435),30900317,CDM,310,RC,81445,HCPCS,facility,both,,,,910.64,910.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (765),30900318,CDM,310,RC,81479,HCPCS,facility,both,,,,1601.48,1601.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (5150),30900319,CDM,310,RC,81479,HCPCS,facility,both,,,,10781.2,10781.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL MJR BP (275),30900320,CDM,310,RC,81206,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL MJR BP (275),30900320,CDM,310,RC,81206,HCPCS,facility,both,,,,465,465,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLT3 GENE (160),30900321,CDM,310,RC,81245,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE (90),30900322,CDM,310,RC,81275,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE (90),30900322,CDM,310,RC,81275,HCPCS,facility,both,,,,365,365,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BRAF GENE (75),30900323,CDM,310,RC,81210,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 4 (305),30900324,CDM,310,RC,81403,HCPCS,facility,both,,,,638.5,638.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHIMERISM ANAL W/CELL SELECT (210),30900325,CDM,310,RC,81268,HCPCS,facility,both,,,,439.62,439.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (2200),30900326,CDM,310,RC,81479,HCPCS,facility,both,,,,3720,3720,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (2200),30900326,CDM,310,RC,81479,HCPCS,facility,both,,,,4605.56,4605.56,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC JAK2 GENE (125),30900327,CDM,310,RC,81270,HCPCS,facility,both,,,,218.75,218.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC JAK2 GENE (125),30900327,CDM,310,RC,81270,HCPCS,facility,both,,,,261.68,261.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CEBPA GENE FULL SEQ (345),30900328,CDM,310,RC,81218,HCPCS,facility,both,,,,722.23,722.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NRAS GENE VAR EXON 2-3 (450),30900329,CDM,310,RC,81311,HCPCS,facility,both,,,,942.05,942.05,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOLE PROC LEVEL 2 (105),30900330,CDM,310,RC,81401,HCPCS,facility,both,,,,219.81,219.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOLE PROC LEVEL 2 (105),30900330,CDM,310,RC,81401,HCPCS,facility,both,,,,165,165,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOLE PROC LEVEL 5 (450),30900331,CDM,310,RC,81404,HCPCS,facility,both,,,,942.05,942.05,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KIT GENE TGT SEQ (415),30900332,CDM,310,RC,81272,HCPCS,facility,both,,,,868.77,868.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE VAR (1),30900333,CDM,310,RC,81276,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE (1),30900334,CDM,310,RC,81246,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KIT GENE TGTD SEQ (1),30900335,CDM,310,RC,81272,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (1650),30900336,CDM,310,RC,81479,HCPCS,facility,both,,,,3454.17,3454.17,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (1650),30900336,CDM,310,RC,81479,HCPCS,facility,both,,,,3065,3065,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHIMERISM ANAL NO SEL (145),30900337,CDM,310,RC,81267,HCPCS,facility,both,,,,303.55,303.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NPM1 GENE (345),30900338,CDM,310,RC,81310,HCPCS,facility,both,,,,722.23,722.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMP22 GENE ANALYSIS,30900339,CDM,310,RC,81325,HCPCS,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EXOME SEQUENCE ANAL (3670),30900340,CDM,310,RC,81415,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EXOME SEQUENCE ANAL (3670),30900340,CDM,310,RC,81415,HCPCS,facility,both,,,,7682.91,7682.91,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPARATOR EXOME (515),30900341,CDM,310,RC,81416,HCPCS,facility,both,,,,1078.12,1078.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GBA GENE (65),30900342,CDM,310,RC,81251,HCPCS,facility,both,,,,136.07,136.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (340),30900343,CDM,310,RC,81401,HCPCS,facility,both,,,,350,350,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 2 (340),30900343,CDM,310,RC,81401,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PTN GENE KNOWN (505),30900344,CDM,310,RC,81322,HCPCS,facility,both,,,,1057.19,1057.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTGN MARRAY COPY NO & SNP (720),30900345,CDM,310,RC,81229,HCPCS,facility,both,,,,1507.28,1507.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTGN MARRAY COPY NO & SNP (720),30900345,CDM,310,RC,81229,HCPCS,facility,both,,,,1263,1263,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTGN MARRAY COPY NO & SNP (815),30900346,CDM,310,RC,81229,HCPCS,facility,both,,,,576,576,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTGN MARRAY COPY NO & SNP (815),30900346,CDM,310,RC,81229,HCPCS,facility,both,,,,1706.15,1706.15,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (610),30900347,CDM,310,RC,81479,HCPCS,facility,both,,,,1276.99,1276.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (610),30900347,CDM,310,RC,81479,HCPCS,facility,both,,,,985,985,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MPATH PROCEDUR LEVEL 5 (2460),30900348,CDM,310,RC,81404,HCPCS,facility,both,,,,5149.86,5149.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA II TYPING  1 LOC LR (120),30900349,CDM,310,RC,81376,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA II TYPING  1 LOC HR (290),30900350,CDM,310,RC,81382,HCPCS,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA CLASS I PHENOTYPE QUAL,30900351,CDM,302,RC,86830,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA CLASS II PHENOTYPE QUAL,30900352,CDM,302,RC,86831,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I TYPING 1 LOCUS LR (55),30900353,CDM,310,RC,81373,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA CLASS I&II ANTIBODY QUAL,30900354,CDM,302,RC,86828,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMP22 GENE DUP/DELET (505),30900355,CDM,310,RC,81324,HCPCS,facility,both,,,,525,525,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PMP22 GENE DUP/DELET (505),30900355,CDM,310,RC,81324,HCPCS,facility,both,,,,1057.19,1057.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PMPP22 GENE DUP/DELET (850),30900356,CDM,310,RC,81324,HCPCS,facility,both,,,,1779.42,1779.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 2 (595),30900357,CDM,310,RC,81401,HCPCS,facility,both,,,,1245.6,1245.6,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 5 (870),30900358,CDM,310,RC,81404,HCPCS,facility,both,,,,740,740,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 5 (870),30900358,CDM,310,RC,81404,HCPCS,facility,both,,,,1821.29,1821.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 5 (1580),30900359,CDM,310,RC,81404,HCPCS,facility,both,,,,3440,3440,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 5 (1580),30900359,CDM,310,RC,81404,HCPCS,facility,both,,,,3307.63,3307.63,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 6 (3030),30900360,CDM,310,RC,81405,HCPCS,facility,both,,,,6343.11,6343.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7  (870),30900361,CDM,310,RC,81406,HCPCS,facility,both,,,,1821.29,1821.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASPA GENE (185),30900362,CDM,310,RC,81200,HCPCS,facility,both,,,,387.29,387.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GJB2 GENE FULL SEQ (220),30900363,CDM,310,RC,81252,HCPCS,facility,both,,,,369,369,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GJB2 GENE FULL SEQ (220),30900363,CDM,310,RC,81252,HCPCS,facility,both,,,,460.55,460.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GJB6 GENE COM VAR (1),30900364,CDM,310,RC,81254,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DMD DUP/DELET ANALYSIS (1340),30900365,CDM,310,RC,81161,HCPCS,facility,both,,,,2805.21,2805.21,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MO PATH PROCEDUR LEVEL 1  (320),30900366,CDM,310,RC,81400,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MO PATH PROCEDUR LEVEL 1  (320),30900366,CDM,310,RC,81400,HCPCS,facility,both,,,,545,545,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MO PATH PROCEDUR LEVEL 6  (320),30900367,CDM,310,RC,81405,HCPCS,facility,both,,,,950,950,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MO PATH PROCEDUR LEVEL 6  (320),30900367,CDM,310,RC,81405,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYS (560),30900368,CDM,310,RC,81450,HCPCS,facility,both,,,,1172.32,1172.32,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL1 GENE MINOR BP (235),30900369,CDM,310,RC,81207,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BCR/ABL1 GENE MINOR BP (235),30900369,CDM,310,RC,81207,HCPCS,facility,both,,,,491.96,491.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN M ARRAY COPY NO&SNP (1115),30900370,CDM,310,RC,81229,HCPCS,facility,both,,,,1950,1950,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTOGEN M ARRAY COPY NO&SNP (1115),30900370,CDM,310,RC,81229,HCPCS,facility,both,,,,2334.18,2334.18,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL1 GENE MAJOR BP (280),30900371,CDM,310,RC,81206,HCPCS,facility,both,,,,586.16,586.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BCR/ABL1 GENE MAJOR BP (320),30900372,CDM,310,RC,81206,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BRAF GENE (205),30900373,CDM,310,RC,81210,HCPCS,facility,both,,,,429.16,429.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BRAF GENE (205),30900373,CDM,310,RC,81210,HCPCS,facility,both,,,,341,341,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CEBPA GENE FULL SEQUENCE (400),30900374,CDM,310,RC,81218,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CEBPA GENE FULL SEQUENCE (400),30900374,CDM,310,RC,81218,HCPCS,facility,both,,,,659,659,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EGFR GENE COM VARIANTS (390),30900375,CDM,310,RC,81235,HCPCS,facility,both,,,,816.44,816.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EGFR GENE COM VARIANTS (390),30900375,CDM,310,RC,81235,HCPCS,facility,both,,,,760,760,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLT3 GENE (190),30900376,CDM,310,RC,81245,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLT3 GENE (190),30900376,CDM,310,RC,81245,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGH GENE REARRANGE AMP METH (180),30900377,CDM,310,RC,81261,HCPCS,facility,both,,,,376.81,376.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGH GENE REARRANGE AMP METH (180),30900377,CDM,310,RC,81261,HCPCS,facility,both,,,,269,269,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STR MARKERS SPECIMEN ANAL (260),30900378,CDM,310,RC,81265,HCPCS,facility,both,,,,440,440,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC STR MARKERS SPECIMEN ANAL (260),30900378,CDM,310,RC,81265,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (320),30900379,CDM,310,RC,81265,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (320),30900379,CDM,310,RC,81265,HCPCS,facility,both,,,,604,604,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHIMERISM ANAL NO CELL SELEC (170),30900380,CDM,310,RC,81267,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHIMERISM ANAL NO CELL SELEC (170),30900380,CDM,310,RC,81267,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHIMERISM ANAL NO CELL SELEC (300),30900381,CDM,310,RC,81267,HCPCS,facility,both,,,,498,498,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHIMERISM ANAL NO CELL SELEC (300),30900381,CDM,310,RC,81267,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHIMERISM ANAL WI/CELL SELECT (245),30900382,CDM,310,RC,81268,HCPCS,facility,both,,,,512.89,512.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHIMERISM ANAL WI/CELL SELECT (245),30900382,CDM,310,RC,81268,HCPCS,facility,both,,,,401,401,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC KIT GENE TARGETED SEQ ANALYS (440),30900383,CDM,310,RC,81272,HCPCS,facility,both,,,,921.12,921.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KIT GENE TARGETED SEQ ANALYS (440),30900383,CDM,310,RC,81272,HCPCS,facility,both,,,,642,642,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MICROSATELLITE INSTABILITY (275),30900384,CDM,310,RC,81301,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MICROSATELLITE INSTABILITY (275),30900384,CDM,310,RC,81301,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NPM1 GENE (400),30900385,CDM,310,RC,81310,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NPM1 GENE (400),30900385,CDM,310,RC,81310,HCPCS,facility,both,,,,648,648,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC NRAS GENE VARIANTS EXON 2&3 (475),30900386,CDM,310,RC,81311,HCPCS,facility,both,,,,994.38,994.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PML/RARALPHA COM  BREAKPOINTS (320),30900387,CDM,310,RC,81315,HCPCS,facility,both,,,,530,530,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PML/RARALPHA COM  BREAKPOINTS (320),30900387,CDM,310,RC,81315,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRG GENE REARRANGEMENT ANAL (230),30900388,CDM,310,RC,81342,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRG GENE REARRANGEMENT ANAL (230),30900388,CDM,310,RC,81342,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 2 (105),30900389,CDM,310,RC,81401,HCPCS,facility,both,,,,219.81,219.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 4 (230),30900390,CDM,310,RC,81403,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (350),30900391,CDM,310,RC,81406,HCPCS,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYS (480),30900392,CDM,310,RC,81445,HCPCS,facility,both,,,,1004.85,1004.85,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYS (530),30900393,CDM,310,RC,81445,HCPCS,facility,both,,,,1109.52,1109.52,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CAR ION CHNNLPATH INC 10 GNS ADDON,30900394,CDM,310,RC,81413,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CAR ION CHNNLPATH INC 10 GNS ADDON,30900394,CDM,310,RC,81413,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CAR ION CHNNLPATH INC 2 GN (2675),30900395,CDM,310,RC,81414,HCPCS,facility,both,,,,5599.94,5599.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE (100),30900396,CDM,310,RC,81245,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE (100),30900396,CDM,310,RC,81245,HCPCS,facility,both,,,,178.75,178.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLT3 GENE ANALSYS (455),30900397,CDM,310,RC,81246,HCPCS,facility,both,,,,952.51,952.51,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE ANALSYS (455),30900397,CDM,310,RC,81246,HCPCS,facility,both,,,,793.75,793.75,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HLA I & II TYPING LR (320),30900398,CDM,310,RC,81370,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA CLASS I HIGH DEFIN QUAL,30900399,CDM,302,RC,86832,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA CLAS II HIGH DEFIN QUAL,30900400,CDM,302,RC,86833,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I & II TYPING HR (580),30900401,CDM,310,RC,81378,HCPCS,facility,both,,,,1214.19,1214.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA X-MATCH NON-CYT ADD-ON,30900402,CDM,310,RC,86826,HCPCS,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I TYPING 1 LOCUS HR (165),30900403,CDM,310,RC,81380,HCPCS,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA I & II TYPE VERIFY LR (150),30900404,CDM,310,RC,81371,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HLA TYPING 1 LOCUS LR (120),30900405,CDM,310,RC,81373,HCPCS,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (505),30900406,CDM,310,RC,81406,HCPCS,facility,both,,,,1057.19,1057.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (505),30900406,CDM,310,RC,81406,HCPCS,facility,both,,,,824,824,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH PROC (1270),30900407,CDM,310,RC,81479,HCPCS,facility,both,,,,2658.66,2658.66,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH PROC (1270),30900407,CDM,310,RC,81479,HCPCS,facility,both,,,,2145,2145,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EXOME SEQUENCE ANAL (2800),30900408,CDM,310,RC,81415,HCPCS,facility,both,,,,5861.63,5861.63,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EXOME SEQUENCE ANAL (2800),30900408,CDM,310,RC,81415,HCPCS,facility,both,,,,4900,4900,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPARATOR EXOME (375),30900409,CDM,310,RC,81416,HCPCS,facility,both,,,,785.04,785.04,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPARATOR EXOME (375),30900409,CDM,310,RC,81416,HCPCS,facility,both,,,,600,600,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOLE PROC (900),30900410,CDM,310,RC,81479,HCPCS,facility,both,,,,1884.09,1884.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (900),30900410,CDM,310,RC,81479,HCPCS,facility,both,,,,1640,1640,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOLE PROC (305),30900411,CDM,310,RC,81479,HCPCS,facility,both,,,,638.5,638.5,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE FULL SEQUENCE (1460),30900412,CDM,310,RC,81223,HCPCS,facility,both,,,,3056.42,3056.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (275),30900413,CDM,310,RC,81479,HCPCS,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 9 (1630),30900414,CDM,310,RC,81408,HCPCS,facility,both,,,,3412.3,3412.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (555),30900415,CDM,310,RC,81479,HCPCS,facility,both,,,,1161.86,1161.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLE PROC (270),30900416,CDM,310,RC,81479,HCPCS,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC DNA HEA 35 AG 11 BLD GRP,30900417,CDM,310,RC,,,facility,both,,,,701.3,701.3,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC DNA HEA 35 AG 11 BLD GRP,30900417,CDM,310,RC,,,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDUR LEVEL 4 (270),30900418,CDM,310,RC,81403,HCPCS,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (340),30900419,CDM,310,RC,81404,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (415),30900420,CDM,310,RC,81404,HCPCS,facility,both,,,,868.77,868.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (565),30900421,CDM,310,RC,81479,HCPCS,facility,both,,,,1182.79,1182.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (190),30900422,CDM,310,RC,81479,HCPCS,facility,both,,,,397.75,397.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (415),30900423,CDM,310,RC,81479,HCPCS,facility,both,,,,868.77,868.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 5 (265),30900424,CDM,310,RC,81404,HCPCS,facility,both,,,,554.76,554.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 6 (590),30900425,CDM,310,RC,81405,HCPCS,facility,both,,,,1235.13,1235.13,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (625),30900426,CDM,310,RC,81479,HCPCS,facility,both,,,,1308.4,1308.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (80),30900427,CDM,310,RC,81479,HCPCS,facility,both,,,,167.48,167.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (75),30900428,CDM,310,RC,81479,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOL PATH (490),30900429,CDM,310,RC,81479,HCPCS,facility,both,,,,1025.79,1025.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS,30900430,CDM,310,RC,81445,HCPCS,facility,both,,,,805.97,805.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS,30900430,CDM,310,RC,81445,HCPCS,facility,both,,,,881,881,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CALR GENE COM VARIANTS (240),30900431,CDM,310,RC,81219,HCPCS,facility,both,,,,502.42,502.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MTHFR GENE (85),30900432,CDM,310,RC,81291,HCPCS,facility,both,,,,177.94,177.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (795),30900433,CDM,310,RC,81450,HCPCS,facility,both,,,,1664.28,1664.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (795),30900433,CDM,310,RC,81450,HCPCS,facility,both,,,,1355,1355,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795),30900434,CDM,310,RC,81455,HCPCS,facility,both,,,,1355,1355,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795),30900434,CDM,310,RC,81455,HCPCS,facility,both,,,,1664.28,1664.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 1 (265),30900435,CDM,310,RC,81400,HCPCS,facility,both,,,,554.76,554.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE COM VARIANTS (70),30900436,CDM,310,RC,81220,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CFTR GENE COM VARIANTS (70),30900436,CDM,310,RC,81220,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ABL1  GENE (200),30900439,CDM,310,RC,81170,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ABL1  GENE (200),30900439,CDM,310,RC,81170,HCPCS,facility,both,,,,340,340,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GJB2 GENE FULL SEQUENCE (470),30900440,CDM,310,RC,81252,HCPCS,facility,both,,,,983.92,983.92,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENE TARGETED SEQUENCE ANALYSIS  (160),30900441,CDM,310,RC,81272,HCPCS,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENE TARGETED SEQUENCE ANALYSIS  (160),30900441,CDM,310,RC,81272,HCPCS,facility,both,,,,272.36,272.36,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 2 (555),30900442,CDM,310,RC,81401,HCPCS,facility,both,,,,902,902,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 2 (555),30900442,CDM,310,RC,81401,HCPCS,facility,both,,,,1161.86,1161.86,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IDH1  COMMON VARIANTS (230),30900443,CDM,310,RC,81120,HCPCS,facility,both,,,,360,360,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IDH1  COMMON VARIANTS (230),30900443,CDM,310,RC,81120,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IDH2  COMMON VARIANTS (230),30900444,CDM,310,RC,81121,HCPCS,facility,both,,,,360,360,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IDH2  COMMON VARIANTS (230),30900444,CDM,310,RC,81121,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IFNL3 GENE (70),30900445,CDM,310,RC,81283,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IFNL3 GENE (70),30900445,CDM,310,RC,81283,HCPCS,facility,both,,,,128,128,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TPMT  GENE COM VARIANTS,30900446,CDM,310,RC,81335,HCPCS,facility,both,,,,240.74,240.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TPMT  GENE COM VARIANTS,30900446,CDM,310,RC,81335,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HPA-1  GENOTYPING (35),30900447,CDM,310,RC,81105,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-2  GENOTYPING (35),30900448,CDM,310,RC,81106,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-3  GENOTYPING (35),30900449,CDM,310,RC,81107,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-4  GENOTYPING (35),30900450,CDM,310,RC,81108,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-5  GENOTYPING (35),30900451,CDM,310,RC,81109,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-6  GENOTYPING (35),30900452,CDM,310,RC,81110,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-9  GENOTYPING (35),30900453,CDM,310,RC,81111,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HPA-15  GENOTYPING (35),30900454,CDM,310,RC,81112,HCPCS,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (260),30900455,CDM,310,RC,81401,HCPCS,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDUR LEVEL 2 (260),30900455,CDM,310,RC,81401,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOL PATH (545),30900456,CDM,310,RC,81479,HCPCS,facility,both,,,,1140.92,1140.92,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC F2 GENE (40),30900457,CDM,310,RC,81240,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC F2 GENE (40),30900457,CDM,310,RC,81240,HCPCS,facility,both,,,,90.5,90.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC F5 GENE (40),30900458,CDM,310,RC,81241,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC F5 GENE (40),30900458,CDM,310,RC,81241,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 2 (210),30900459,CDM,310,RC,81401,HCPCS,facility,both,,,,395.95,395.95,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 2 (210),30900459,CDM,310,RC,81401,HCPCS,facility,both,,,,439.62,439.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (1490),30900460,CDM,310,RC,81406,HCPCS,facility,both,,,,2870,2870,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROCEDURE LEVEL 7 (1490),30900460,CDM,310,RC,81406,HCPCS,facility,both,,,,3119.23,3119.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MECP2 GENE FULL SEQ (340),30900461,CDM,310,RC,81302,HCPCS,facility,both,,,,631,631,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MECP2 GENE FULL SEQ (340),30900461,CDM,310,RC,81302,HCPCS,facility,both,,,,711.77,711.77,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASHKENAZI JEWISH ASSOC DIS (730),30900462,CDM,310,RC,81412,HCPCS,facility,both,,,,1528.21,1528.21,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ASHKENAZI JEWISH ASSOC DIS (730),30900462,CDM,310,RC,81412,HCPCS,facility,both,,,,537,537,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BCR/ABL1 GENE MAJOR BP QUAN,30900463,CDM,310,RC,,,facility,both,,,,575.7,575.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HTT GENE DETC ABNOR ALLELES (225),30900464,CDM,310,RC,81271,HCPCS,facility,both,,,,471.02,471.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TERT GENE TARGETED SEQ ALYS (2230),30900465,CDM,310,RC,81345,HCPCS,facility,both,,,,4668.36,4668.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE (210),30900466,CDM,310,RC,81275,HCPCS,facility,both,,,,419,419,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC KRAS GENE (210),30900466,CDM,310,RC,81275,HCPCS,facility,both,,,,439.62,439.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC KRAS GENE VAR (250),30900467,CDM,310,RC,81276,HCPCS,facility,both,,,,523.36,523.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MGMT GENE PMTR MTHYLTN ALYS (355),30900468,CDM,310,RC,81287,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MGMT GENE PMTR MTHYLTN ALYS (355),30900468,CDM,310,RC,81287,HCPCS,facility,both,,,,743.17,743.17,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGENOMIC NEO MICRORA ALYS (350),30900469,CDM,310,RC,81277,HCPCS,facility,both,,,,548,548,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTOGENOMIC NEO MICRORA ALYS (350),30900469,CDM,310,RC,81277,HCPCS,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (966),30900470,CDM,310,RC,81406,HCPCS,facility,both,,,,2022.26,2022.26,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (966),30900470,CDM,310,RC,81406,HCPCS,facility,both,,,,1760,1760,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS (1426),30900471,CDM,310,RC,81455,HCPCS,facility,both,,,,2985.24,2985.24,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGEN M ARRAY COPY NO & SNP (417),30900472,CDM,310,RC,81229,HCPCS,facility,both,,,,872.96,872.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (202),30900473,CDM,310,RC,81455,HCPCS,facility,both,,,,385,385,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS (202),30900473,CDM,310,RC,81455,HCPCS,facility,both,,,,422.87,422.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (328),30900474,CDM,310,RC,81455,HCPCS,facility,both,,,,585,585,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS (328),30900474,CDM,310,RC,81455,HCPCS,facility,both,,,,686.65,686.65,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (467),30900475,CDM,310,RC,81455,HCPCS,facility,both,,,,785,785,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TARGETED GENOMIC SEQ ANALYSIS (467),30900475,CDM,310,RC,81455,HCPCS,facility,both,,,,977.64,977.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IGK GENE PART OF PANEL (154),30900476,CDM,310,RC,81264,HCPCS,facility,both,,,,322.39,322.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLECULAR PATHOLOGY (1357),30900477,CDM,310,RC,81479,HCPCS,facility,both,,,,2580,2580,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC UNLISTED MOLECULAR PATHOLOGY (1357),30900477,CDM,310,RC,81479,HCPCS,facility,both,,,,2840.79,2840.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 4 (108),30900478,CDM,310,RC,81403,HCPCS,facility,both,,,,226.09,226.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (170),30900479,CDM,310,RC,81455,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (170),30900479,CDM,310,RC,81455,HCPCS,facility,both,,,,340,340,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MOPATH PROC LEVEL 8 (608),30900480,CDM,310,RC,81407,HCPCS,facility,both,,,,1272.81,1272.81,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROC LEVEL 9 (778),30900481,CDM,310,RC,81408,HCPCS,facility,both,,,,1628.7,1628.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC STR MARKERS SPECIMEN ANAL (109),30900482,CDM,310,RC,81265,HCPCS,facility,both,,,,228.19,228.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (342),30900483,CDM,310,RC,81445,HCPCS,facility,both,,,,715.96,715.96,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IADNA CNS PTHGN NEXT GEN SEQ(780),30900484,CDM,310,RC,,,facility,both,,,,1632.88,1632.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 12/31/2023 HC LIVER DISEASE ALYS 3 BMRK SRM ALG (171),30900485,CDM,309,RC,,,facility,both,,,,357.97,357.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOPATH FL NONGYN SMEARS,31000001,CDM,311,RC,88104,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CP SMR OTHR; SCRN & INT,31000002,CDM,311,RC,88160,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLOW CYTOMETRY EA ADDTL MARKER,31000003,CDM,311,RC,88185,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLOW CYTOMETRY EA ADDTL MARKER,31000003,CDM,311,RC,88185,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; BM BLD CELLS,31000004,CDM,310,RC,88237,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; BM BLD CELLS,31000004,CDM,310,RC,88237,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TISSUE CULTURE; OTHER TISSUE,31000005,CDM,319,RC,88239,HCPCS,facility,both,,,,523.36,523.36,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; OTHER TISSUE,31000005,CDM,319,RC,88239,HCPCS,facility,both,,,,604,604,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; 45 CELLS,31000006,CDM,319,RC,88263,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MCG; SITU HYBRID 10-30 CELLS,31000008,CDM,310,RC,88273,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MCG; SITU HYBRID 10-30 CELLS,31000008,CDM,310,RC,88273,HCPCS,facility,both,,,,366.35,366.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MCG; IP SITU 25-99 CELLS,31000009,CDM,310,RC,88274,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MCG; IP SITU 25-99 CELLS,31000009,CDM,310,RC,88274,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; ADDTL BANDING,31000010,CDM,319,RC,88283,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; ADDTL CELL COUNTS,31000011,CDM,310,RC,88285,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; ADDTL CELL COUNTS,31000011,CDM,310,RC,88285,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE EXAM BY PATHOLOGIST LVL 4,31000012,CDM,310,RC,88305,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ENZYME HISTOCHEMISTRY,31000013,CDM,310,RC,88319,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ENZYME HISTOCHEMISTRY,31000013,CDM,310,RC,88319,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PATH CONSULT DURING SURGERY,31000014,CDM,310,RC,88329,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INTRAOP CYTO PATH CONSULT 1,31000015,CDM,311,RC,88333,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INTRAOP CYTO PATH CONSULT 2,31000016,CDM,311,RC,88334,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IHC EACH ANTIBODY,31000017,CDM,310,RC,88342,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IHC EACH ANTIBODY,31000017,CDM,310,RC,88342,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC IF STAIN , INITIAL",31000018,CDM,310,RC,88346,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IF EA AB; INDIRECT,31000019,CDM,310,RC,88347,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IF EA AB; INDIRECT,31000019,CDM,310,RC,88347,HCPCS,facility,both,,,,183.87,183.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MORPHOMETRICS; NERVE,31000020,CDM,310,RC,88356,HCPCS,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MANUAL TUMOR IM HISTOCHEM EA AB,31000021,CDM,310,RC,88360,HCPCS,facility,both,,,,157.01,157.01,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE IDENTITY TYPING,31000023,CDM,310,RC,88380,HCPCS,facility,both,,,,393,393,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TISSUE IDENTITY TYPING,31000023,CDM,310,RC,88380,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MICRODISSECTION MANUAL,31000025,CDM,310,RC,88381,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CELL COUNT NOT BLOOD,31000041,CDM,300,RC,89050,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE
HC CELL COUNT NOT BLOOD,31000041,CDM,300,RC,89050,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CELL COUNT NOT BLOOD,31000041,CDM,300,RC,89050,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELL COUNT NOT BLOOD,31000041,CDM,300,RC,89050,HCPCS,facility,both,,,,4.72,4.72,,,,,,,,,,,,,Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE
"HC MORPHOMETRIC ANAL,BONE",31000042,CDM,310,RC,88399,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC IMMUNOFLUOR STN, ADD",31000043,CDM,310,RC,88350,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
DEAC 2/8/2017 HC CYTP URNE 3-5 PROBES EA SPEC,31000100,CDM,311,RC,88120,HCPCS,facility,both,,,,900.9,900.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC  IHC ADD SINGLE AB STN,EACH",31000114,CDM,310,RC,88341,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MULTIPLEX AB STN EACH,31000115,CDM,310,RC,88344,HCPCS,facility,both,,,,177.94,177.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC CYTOPATH, ISH, URIN C MORPHOM (140)",31000116,CDM,310,RC,88120,HCPCS,facility,both,,,,570,570,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC CYTOPATH, ISH, URIN C MORPHOM (140)",31000116,CDM,310,RC,88120,HCPCS,facility,both,,,,293.09,293.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50),31000119,CDM,310,RC,88377,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50),31000119,CDM,310,RC,88377,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC EXOME RE-EVALUATION,31000120,CDM,310,RC,81417,HCPCS,facility,both,,,,2840.79,2840.79,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMN1   GENE DOS/DELETION ALYS (395),31000121,CDM,310,RC,81329,HCPCS,facility,both,,,,826.9,826.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SMN1   GENE DOS/DELETION ALYS (395),31000121,CDM,310,RC,81329,HCPCS,facility,both,,,,693,693,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTP URINE 3-5 PROBES CMPTR (122),31000122,CDM,310,RC,88121,HCPCS,facility,both,,,,255.4,255.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EXOME RE-EVALUATION (1840),31000123,CDM,310,RC,81417,HCPCS,facility,both,,,,3851.92,3851.92,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MYD88 GENE P. LEU265PRO VRNT (300),31000125,CDM,310,RC,81305,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEM VW DS VW FACTOR & COLLAGEN III BINDING ELISA,31000128,CDM,310,RC,,,facility,both,,,,401.94,401.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC CYP2C9, GENE ANALYSIS, COMMON VARIANTS(30)",31000131,CDM,310,RC,81227,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC CYP2D6, GENE ANALYSIS, COMMON VARIANTS(30)",31000132,CDM,310,RC,81226,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC CYP3A4, GENE ANALYSIS, COMMON VARIANTS(30)",31000133,CDM,310,RC,81230,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC CYP3A5, GENE ANALYSIS, COMMON VARIANTS(30)",31000134,CDM,310,RC,81231,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC DPYD, GENE ANALYSIS, COMMON VARIANTS(30)",31000135,CDM,310,RC,81232,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC NUDT15, GENE ANALYSIS, COMMON VARIANTS(30)",31000136,CDM,310,RC,81306,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC SLCO1BI, GENE ANALYSIS, COMMON VARIANTS(30)",31000137,CDM,310,RC,81328,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"DEAC 4/1/2023 HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)",31000138,CDM,310,RC,81355,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC FETAL CONGENTIAL ABNORML ASSAY TWO PROTEINS (PAPP-A, HCG) (25)",31000140,CDM,310,RC,81508,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS (263),31000141,CDM,310,RC,81455,HCPCS,facility,both,,,,550.57,550.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC ANALYSIS(170),31000142,CDM,310,RC,81456,HCPCS,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC VERSITI HEPARININDUCED THROMBOCYTOPENIA EVALUATION  PEA(170),31000143,CDM,310,RC,,,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC UGT1A1, GENE ANALYSIS, COMMON VARIANTS(85)",31000144,CDM,310,RC,81350,HCPCS,facility,both,,,,177.94,177.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)",31000147,CDM,310,RC,81335,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC INFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2,31000150,CDM,310,RC,,,facility,both,,,,376.2,376.2,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLT3 GENE (795),31000152,CDM,310,RC,81245,HCPCS,facility,both,,,,1664.28,1664.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CARDIOMYOPATHY  PANEL (296),31000153,CDM,310,RC,81439,HCPCS,facility,both,,,,619.66,619.66,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMBINED CARDIAC  PANEL SEQUENCING AT LEAST 10 GENES (148),31000154,CDM,310,RC,81413,HCPCS,facility,both,,,,309.83,309.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMBINED CARDIAC  PANEL ANALYSIS AT LEAST 2 GENES (148),31000155,CDM,310,RC,81414,HCPCS,facility,both,,,,309.83,309.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENOMEXPRESS (1109),31000156,CDM,310,RC,81425,HCPCS,facility,both,,,,2321.62,2321.62,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC GENOMEXPRESS SEQUENCE ANALYSIS, EA COMPARATOR GENOME (554)",31000157,CDM,310,RC,81426,HCPCS,facility,both,,,,1159.76,1159.76,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WHOLE MITO GENOME SEQUENCING & DELETION TESTING (148),31000158,CDM,310,RC,81460,HCPCS,facility,both,,,,309.83,309.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MITO GENOME SEQUENCING HETEROPLASMY DETECTION, IF PERFRMD (148)",31000159,CDM,310,RC,81465,HCPCS,facility,both,,,,309.83,309.83,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NOONAN AND COMPREHENSIVE RASOPATHIES  PANEL (296),31000160,CDM,310,RC,81442,HCPCS,facility,both,,,,619.66,619.66,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ONE KNOWN FAMILIAL VARIANT (136),31000161,CDM,310,RC,81455,HCPCS,facility,both,,,,284.71,284.71,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRENATAL KNOWN FAMILIAL MUTATION (INCLUDES MCC) (370),31000162,CDM,310,RC,81265,HCPCS,facility,both,,,,774.57,774.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE (370),31000163,CDM,310,RC,81479,HCPCS,facility,both,,,,774.57,774.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TWO KNOWN FAMILIAL VARIANTS IN A NUCLEAR GENE (98),31000164,CDM,310,RC,81455,HCPCS,facility,both,,,,205.16,205.16,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROMOSOMAL MICROARRAY (MICROARRAYDX) (296),31000165,CDM,310,RC,81229,HCPCS,facility,both,,,,619.66,619.66,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC XOMEDXXPRESS (739),31000166,CDM,310,RC,81415,HCPCS,facility,both,,,,1547.05,1547.05,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC XOMEDXXPRESS SEQ ANALYSIS, EA COMPARATOR EXOME (370)",31000167,CDM,310,RC,81416,HCPCS,facility,both,,,,774.57,774.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOKINE 13 PANEL (13),31000168,CDM,310,RC,83520,HCPCS,facility,both,,,,27.22,27.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MOLECULAR PATH PROC, LEVEL 4  (71)",31000169,CDM,310,RC,81403,HCPCS,facility,both,,,,148.64,148.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC-NPM1 GENE (874),31000170,CDM,310,RC,81310,HCPCS,facility,both,,,,1829.66,1829.66,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TARGETED GENOMIC SEQ ANALYSIS 324 GENES (795),31000171,CDM,310,RC,,,facility,both,,,,1664.28,1664.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 5 (246),31000172,CDM,310,RC,81404,HCPCS,facility,both,,,,514.99,514.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 6 (123),31000173,CDM,310,RC,81405,HCPCS,facility,both,,,,257.49,257.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (83),31000174,CDM,310,RC,81406,HCPCS,facility,both,,,,173.75,173.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPARATOR EXOME (247),31000175,CDM,310,RC,81416,HCPCS,facility,both,,,,517.08,517.08,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPARATOR EXOME (493),31000176,CDM,310,RC,81416,HCPCS,facility,both,,,,1032.06,1032.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EXOME SEQUENCE ANALYSIS (1232),31000177,CDM,310,RC,81415,HCPCS,facility,both,,,,2579.11,2579.11,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EXOME RE-EVALUATION (493),31000178,CDM,310,RC,81417,HCPCS,facility,both,,,,1032.06,1032.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENOME SEQUENCE ANALYSIS (1970),31000179,CDM,310,RC,81425,HCPCS,facility,both,,,,4124.07,4124.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GENOME SEQUENCE ANALYSIS (985),31000180,CDM,310,RC,81425,HCPCS,facility,both,,,,2062.04,2062.04,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC GENOME SEQ ANALYSIS, EA CMPRTR (493)",31000181,CDM,310,RC,81426,HCPCS,facility,both,,,,1032.06,1032.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC GENOME SEQ ANALYSIS, EA CMPRTR (985)",31000182,CDM,310,RC,81426,HCPCS,facility,both,,,,2062.04,2062.04,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 6 (99),31000183,CDM,310,RC,81405,HCPCS,facility,both,,,,207.25,207.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 7 (49),31000184,CDM,310,RC,81406,HCPCS,facility,both,,,,102.58,102.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 2 (99),31000185,CDM,310,RC,81401,HCPCS,facility,both,,,,207.25,207.25,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MOPATH PROCEDURE LEVEL 2 (49),31000186,CDM,310,RC,81401,HCPCS,facility,both,,,,102.58,102.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ACTIONABLE PHARMACOGENOMICS PANEL (284),31000187,CDM,310,RC,81418,HCPCS,facility,both,,,,594.54,594.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOG GEN-WIDE ALYS HEM MAL STRUX VRNT&CNV OGM (271),31000188,CDM,310,RC,81195,HCPCS,facility,both,,,,567.32,567.32,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS (261),31000189,CDM,310,RC,81450,HCPCS,facility,both,,,,546.39,546.39,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC  NFCT DS STRN TYP WHL GENOME SEQUENCING PR ISOL,31000190,CDM,310,RC,,,facility,both,,,,290.99,290.99,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC 14-3-3 PROTEIN, CSF - PRION DISEASE, RT-QUIC",31000191,CDM,310,RC,,,facility,both,,,,228.19,228.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC MO PATH LEVEL 2, CBFB-MYH11,QUANT, V (481)",31000192,CDM,310,RC,81401,HCPCS,facility,both,,,,1006.94,1006.94,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC NFCT DS CSF METAGENOMIC NGS BIOINFORMATIC ALYS,31000193,CDM,310,RC,,,facility,both,,,,3259.48,3259.48,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOGENOMIC NEO MICRORA ALYS (715),31060019,CDM,310,RC,81277,HCPCS,facility,both,,,,1496.8,1496.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LAB CYCTOLOGY,31100000,CDM,311,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOPATH CELL ENHANCE TECH,31100001,CDM,311,RC,88112,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CP CERV/VAG; ATL; MANUAL SCRN,31100002,CDM,311,RC,88142,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CP SMR OTHR; PREP SCRN INT,31100003,CDM,311,RC,88161,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTP DX EVAL FNA 1ST EA SITE,31100004,CDM,311,RC,88172,HCPCS,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC EVAL OF FNA; INT & REP,31100005,CDM,311,RC,88173,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FLOW CYTOMETRY TC 1ST MARKER,31100006,CDM,311,RC,88184,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FLOW CYTOMETRY TC 1ST MARKER,31100006,CDM,311,RC,88184,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CRYOPRESERVATION EA CELL LINE,31100007,CDM,310,RC,88240,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CRYOPRESERVATION EA CELL LINE,31100007,CDM,310,RC,88240,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC THAW FROZEN CELLS/ALIQUOT,31100008,CDM,319,RC,88241,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC THAW FROZEN CELLS/ALIQUOT,31100008,CDM,319,RC,88241,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC ELECTRON MICRO; DX,31100009,CDM,310,RC,88348,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ISH SINGLE PROBE 1ST,31100010,CDM,312,RC,88365,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BETHESDA PAP; MAN SCRN,31100011,CDM,311,RC,88164,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BETHESDA PAP; MAN SCRN,31100011,CDM,311,RC,88164,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CYTOPATH C/V INTERPRET,31100050,CDM,311,RC,88141,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CELL MARKER STUDY,31100051,CDM,319,RC,88182,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CELL MARKER STUDY,31100051,CDM,319,RC,88182,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CYTOPATH C/V INDEX ADD-ON,31100057,CDM,311,RC,88155,HCPCS,facility,both,,,,46.06,46.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ISH PROBE ADDITIONAL,31100061,CDM,312,RC,88364,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC ISH MULTIPLEX PROBE,31100062,CDM,310,RC,88366,HCPCS,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LAB HISTOLOGY,31200000,CDM,312,RC,,,facility,both,,,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CP CONCENTR TECH SMEAR,31200001,CDM,311,RC,88108,HCPCS,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CP CONCENTR TECH SMEAR,31200001,CDM,311,RC,88108,HCPCS,facility,both,,,,29.5,29.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC SURG PATH LEVEL-I GROSS ONLY,31200002,CDM,310,RC,88300,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SURG PATH LVL 2,31200003,CDM,310,RC,88302,HCPCS,facility,both,,,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE EXAM BY PATHOLOGIST LVL 3,31200004,CDM,310,RC,88304,HCPCS,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE EXAM BY PATHOLOGIST LVL 5,31200005,CDM,310,RC,88307,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE EXAM BY PATHOLOGIST LVL 6,31200006,CDM,310,RC,88309,HCPCS,facility,both,,,,261.68,261.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC DECALCIFICATION,31200007,CDM,310,RC,88311,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SPECIAL STAINS GROUP 1,31200008,CDM,310,RC,88312,HCPCS,facility,both,,,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SPECIAL STAINS GROUP 2,31200009,CDM,310,RC,88313,HCPCS,facility,both,,,,20.93,20.93,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SPECIAL STAINS GROUP 2,31200009,CDM,310,RC,88313,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC HISTOCHEMICAL STAINS ADD-ON,31200010,CDM,310,RC,88314,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC SP CONSULT; 1ST TB W FS SGL SP,31200011,CDM,310,RC,88331,HCPCS,facility,both,,,,62.8,62.8,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PATH CONSULT INTRAOP ADDL,31200012,CDM,310,RC,88332,HCPCS,facility,both,,,,10.46,10.46,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; SKIN OR SOLID BX,31900001,CDM,319,RC,88233,HCPCS,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TISSUE CULTURE; SKIN OR SOLID BX,31900001,CDM,319,RC,88233,HCPCS,facility,both,,,,418.68,418.68,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TISSUE CULTURE; AMNIOTIC FLUID,31900002,CDM,319,RC,88235,HCPCS,facility,both,,,,600,600,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC TISSUE CULTURE; AMNIOTIC FLUID,31900002,CDM,319,RC,88235,HCPCS,facility,both,,,,314.02,314.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; 50-100 CELLS,31900003,CDM,319,RC,88248,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; 50-100 CELLS,31900003,CDM,319,RC,88248,HCPCS,facility,both,,,,708,708,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; 15-20 CELLS,31900004,CDM,310,RC,88262,HCPCS,facility,both,,,,669.9,669.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; 15-20 CELLS,31900004,CDM,310,RC,88262,HCPCS,facility,both,,,,424.5,424.5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; 20-25 CELLS,31900005,CDM,310,RC,88264,HCPCS,facility,both,,,,837.38,837.38,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; 20-25 CELLS,31900005,CDM,310,RC,88264,HCPCS,facility,both,,,,370,370,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; AF/CV 15 CELLS,31900006,CDM,319,RC,88267,HCPCS,facility,both,,,,628.03,628.03,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; AF/CV 15 CELLS,31900006,CDM,319,RC,88267,HCPCS,facility,both,,,,735,735,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MCG; IP SITU 100-300 CELLS,31900007,CDM,310,RC,88275,HCPCS,facility,both,,,,481.49,481.49,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC MCG; IP SITU 100-300 CELLS,31900007,CDM,310,RC,88275,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; ADDTL KARYOT EA STUDY,31900008,CDM,310,RC,88280,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CHROM ANALY; ADDTL KARYOT EA STUDY,31900008,CDM,310,RC,88280,HCPCS,facility,both,,,,41.87,41.87,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; ADDTL HI RESOLN,31900009,CDM,319,RC,88289,HCPCS,facility,both,,,,209.35,209.35,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CHROM ANALY; ADDTL HI RESOLN,31900009,CDM,319,RC,88289,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC MICRODISSECTION LASER (600),31900012,CDM,319,RC,88380,HCPCS,facility,both,,,,1256.06,1256.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC X-RAY EXAM OF EYE, DETECTION OF FOREIGN BODY",32000002,CDM,320,RC,70030,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC MANDIBLE, LESS THAN 4 VIEWS",32000003,CDM,320,RC,70100,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC MANDIBLE, MIN 4 VIEWS",32000004,CDM,320,RC,70110,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  FACIAL BONES, LESS THAN 3 VIEWS",32000005,CDM,320,RC,70140,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  FACIAL BONES, MIN 3 VIEWS",32000006,CDM,320,RC,70150,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  NASAL BONES, MIN 3 VIEWS",32000007,CDM,320,RC,70160,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  ORBITS, MIN 4 VIEWS",32000008,CDM,320,RC,70200,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SINUSES, PARANASAL, LESS THAN 3 VIEWS",32000009,CDM,320,RC,70210,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SINUSES, PARANASAL, MIN 3 VIEWS",32000010,CDM,320,RC,70220,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SKULL, LESS THAN 4 VIEWS",32000011,CDM,320,RC,70250,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SKULL, MIN 4 VIEWS",32000012,CDM,320,RC,70260,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  TEMPOROMANDIBULAR JOINT, BILAT",32000013,CDM,320,RC,70330,HCPCS,facility,both,,,,421.5,421.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  NECK, SOFT TISSUE",32000014,CDM,320,RC,70360,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, SINGLE VIEW, SPECIFY LEVEL",32000015,CDM,320,RC,72020,HCPCS,facility,both,,,,168.6,168.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, CERVICAL, 2 OR 3 VIEWS",32000016,CDM,320,RC,72040,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, CERVICAL, MIN 4 VIEWS",32000017,CDM,320,RC,72050,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, CERVICAL, COMPLETE",32000018,CDM,320,RC,72052,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, THORAX, 2 VIEWS",32000019,CDM,320,RC,72070,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, THORAX, 3 VIEWS",32000020,CDM,320,RC,72072,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, THORAX, MIN 4 VIEWS",32000021,CDM,320,RC,72074,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, THORACOLUMBAR, 2 VIEWS",32000022,CDM,320,RC,72080,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, SCOLIOSIS STUDY",32000023,CDM,320,RC,72090,HCPCS,facility,both,,,,493.25,493.25,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, LUMBOSACRAL, 2 OR 3 VIEWS",32000024,CDM,320,RC,72100,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, LUMBOSACRAL, MIN 4 VIEWS",32000025,CDM,320,RC,72110,HCPCS,facility,both,,,,379.36,379.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC  SPINE, LUMBOSACRAL, MIN 6 VIEWS",32000026,CDM,320,RC,72114,HCPCS,facility,both,,,,547.96,547.96,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM PELVIS, 1 OR 2 VIEWS",32000027,CDM,320,RC,72170,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM PELVIS, MIN 3 VIEWS",32000028,CDM,320,RC,72190,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SACROILIAC JOINTS, 3 OR MORE VIEWS",32000029,CDM,320,RC,72202,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SACRUM AND COCCYX, MIN 2 VIEWS",32000030,CDM,320,RC,72220,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC MYELOGRAPHY, CERVICAL S & I",32000031,CDM,320,RC,72240,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC MYELOGRAPHY, THORACIC S & I",32000032,CDM,320,RC,72255,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC MYELOGRAPHY, LUMBOSACRAL S & I",32000033,CDM,320,RC,72265,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC MYELOGRAPHY, 2 OR MORE REGIONS S & I",32000034,CDM,320,RC,72270,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC DISCOGRAPHY, CERVICAL OR THORACIC S & I",32000035,CDM,320,RC,72285,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC DISCOGRAPHY, CERVICAL OR THORACIC S & I",32000035,CDM,320,RC,72285,HCPCS,facility,both,,,,1775.7,1775.7,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DISCOGRAPHY, LUMBAR",32000037,CDM,320,RC,72295,HCPCS,facility,both,,,,1775.7,1775.7,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DISCOGRAPHY, LUMBAR",32000037,CDM,320,RC,72295,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC RAD EXAM CLAVICLE, COMPLETE",32000038,CDM,320,RC,73000,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SCAPULA, COMPLETE",32000039,CDM,320,RC,73010,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SHOULDER, 1 VIEW",32000040,CDM,320,RC,73020,HCPCS,facility,both,,,,168.6,168.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SHOULDER, MIN 2 VIEWS",32000041,CDM,320,RC,73030,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM ACROMIOCLAVICULAR JOINTS, BILAT",32000042,CDM,320,RC,73050,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM HUMERUS, MIN 2 VIEWS",32000043,CDM,320,RC,73060,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM ELBOW, 2 VIEWS",32000044,CDM,320,RC,73070,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM ELBOW, MIN 3 VIEWS",32000045,CDM,320,RC,73080,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM FOREARM, 2 VIEWS",32000046,CDM,320,RC,73090,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM UPPER EXT INFANT MIN 2 VIEWS,32000047,CDM,320,RC,73092,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM WRIST, 2 VIEWS",32000048,CDM,320,RC,73100,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM WRIST, MIN 3 VIEWS",32000049,CDM,320,RC,73110,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM HAND, 2 VIEWS",32000050,CDM,320,RC,73120,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM HAND, MIN 3 VIEWS",32000051,CDM,320,RC,73130,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM FINGER(S), MIN 2 VIEWS",32000052,CDM,320,RC,73140,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM HIP UNILATERAL 1 VIEW,32000053,CDM,320,RC,73500,HCPCS,facility,both,,,,197.3,197.3,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM HIP UNILATERAL MIN 2 VIEWS,32000054,CDM,320,RC,73510,HCPCS,facility,both,,,,394.6,394.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM HIPS BILATERAL MIN 2 VIEWS EACH HIP,32000055,CDM,320,RC,73520,HCPCS,facility,both,,,,591.9,591.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM DURING OP PROC UP TO 4 STUDIES,32000056,CDM,320,RC,73530,HCPCS,facility,both,,,,789.2,789.2,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM PELVIS & HIPS INFANT/CHILD MIN 2 VIEW,32000057,CDM,320,RC,73540,HCPCS,facility,both,,,,394.6,394.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM FEMUR 2 VIEWS,32000058,CDM,320,RC,73550,HCPCS,facility,both,,,,295.95,295.95,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM KNEE 1 OR 2 VIEWS,32000059,CDM,320,RC,73560,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM KNEE 3 VIEWS,32000060,CDM,320,RC,73562,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM KNEE 4 OR MORE VIEWS,32000061,CDM,320,RC,73564,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM BOTH KNEES STANDING AP MIN 3 VIEWS,32000062,CDM,320,RC,73565,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM TIBIA AND FIBULA 2 VIEWS,32000063,CDM,320,RC,73590,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM LOWER EXT INFANT MIN 2 VIEWS,32000064,CDM,320,RC,73592,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM ANKLE 2 VIEWS,32000065,CDM,320,RC,73600,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM ANKLE MIN 3 VIEWS,32000067,CDM,320,RC,73610,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM FOOT MIN 3 VIEWS,32000068,CDM,320,RC,73630,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM CALCANEUS MIN 2 VIEWS,32000069,CDM,320,RC,73650,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM TOE(S) MIN 2 VIEWS,32000070,CDM,320,RC,73660,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EX ABDOMEN SINGLE AP VIEW,32000071,CDM,320,RC,74000,HCPCS,facility,both,,,,141.36,141.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EX ABDOMEN AP + OBLIQ & CONE VIEWS,32000072,CDM,320,RC,74010,HCPCS,facility,both,,,,247.38,247.38,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EX ABDOMEN DECUBITUS AND/OR ERECT VWS,32000073,CDM,320,RC,74020,HCPCS,facility,both,,,,247.38,247.38,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM; COMPL ACUTE ABD SERIES, INCL 2+ VIEWS ABD, & SNGL VIEW CHEST",32000074,CDM,320,RC,74022,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM; PHRYNX&/CRV ESOPH, INCL SCOUT RAD(S)&DLY IMG(S), CONTR STDY",32000076,CDM,320,RC,74210,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM; ESOPH, INCL SCOUT RAD(S)&DLY IMG(S), SNGL-CONTRAST STDY",32000077,CDM,320,RC,74220,HCPCS,facility,both,,,,758.71,758.71,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EX, SWALL FUNC W/CIN/VID RAD, INCL SCOUT RAD(S)&IMG(S), CONTR STDY",32000078,CDM,320,RC,74230,HCPCS,facility,both,,,,1180.22,1180.22,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EX UPPER GASTROINTESTINAL TRACT W/KUB,32000079,CDM,320,RC,74241,HCPCS,facility,both,,,,715.07,715.07,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EX UPPER GI W/SMALL INTESTINE SERIES,32000080,CDM,320,RC,74245,HCPCS,facility,both,,,,1088.15,1088.15,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EX UPPER GI AIR CONTRAST W/KUB,32000081,CDM,320,RC,74247,HCPCS,facility,both,,,,932.7,932.7,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), SNGL-CONTR STDY",32000082,CDM,320,RC,74250,HCPCS,facility,both,,,,927.31,927.31,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), DBL- CONTR STDY",32000083,CDM,320,RC,74251,HCPCS,facility,both,,,,4552.27,4552.27,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM, COLON, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY",32000084,CDM,320,RC,74270,HCPCS,facility,both,,,,1348.82,1348.82,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM, COLON,INCL SCOUT ABD RAD(S) & DLY IMG(S), DBL-CONTR STDY",32000085,CDM,320,RC,74280,HCPCS,facility,both,,,,1938.93,1938.93,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHOLANGIOGRAPHY/PANCREATOGRAPHY INTRAOP,32000087,CDM,320,RC,74300,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CHOLANGIOGRAPHY/PANCREATOGRAPHY INTRAOP,32000087,CDM,320,RC,74300,HCPCS,facility,both,,,,591.9,591.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHOLANGIOGRAPHY/PANCREATOGRAPHY POSTOP,32000088,CDM,320,RC,74305,HCPCS,facility,both,,,,591.9,591.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHOLANGIOGRAPHY/PANCREATOGRAPHY POSTOP,32000088,CDM,320,RC,74305,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CHOLANGIOGRAM PERCUTANEOUS TRANSHEPATIC,32000089,CDM,320,RC,74320,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC POSTOP BILIARY DUCT CALCULUS REMOVAL,32000090,CDM,320,RC,74327,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ENDOSCOPIC CATH BILIARY DUCTAL SYSTEM,32000091,CDM,320,RC,74328,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC INTRO LONG GI TUBE INC MULTI FLUORO & FILMS,32000092,CDM,320,RC,74340,HCPCS,facility,both,,,,493.25,493.25,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC INTRO LONG GI TUBE INC MULTI FLUORO & FILMS,32000092,CDM,320,RC,74340,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC PERC TRANSHEPATIC DILATION BILIARY DUCT,32000093,CDM,320,RC,74363,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC UROGRAPHY IV W OR W/O KUB/TOMOGRAPH,32000094,CDM,320,RC,74400,HCPCS,facility,both,,,,1180.22,1180.22,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UROGRAPHY IV W OR W/O KUB/TOMOGRAPH,32000094,CDM,320,RC,74400,HCPCS,facility,both,,,,89.37,89.37,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC UROGRAPHY RETROGRADE W OR W/O KUB,32000095,CDM,320,RC,74420,HCPCS,facility,both,,,,1306.67,1306.67,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UROGRAPHY ANTEGRADE S& I,32000096,CDM,320,RC,74425,HCPCS,facility,both,,,,986.5,986.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UROGRAPHY ANTEGRADE S& I,32000096,CDM,320,RC,74425,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CYSTOGRAPHY MIN 3 VIEWS,32000097,CDM,320,RC,74430,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CYSTOGRAPHY MIN 3 VIEWS,32000097,CDM,320,RC,74430,HCPCS,facility,both,,,,986.5,986.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC URETHROCYSTOGRAPHY RETROGRADE S & I,32000098,CDM,320,RC,74450,HCPCS,facility,both,,,,986.5,986.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC URETHROCYSTOGRAPHY RETROGRADE S & I,32000098,CDM,320,RC,74450,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC URETHROCYSTOGRAPHY VOIDING S & I,32000099,CDM,320,RC,74455,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC URETHROCYSTOGRAPHY VOIDING S & I,32000099,CDM,320,RC,74455,HCPCS,facility,both,,,,986.5,986.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC INSERT INTRACATH OR CATH RENAL PELVIS, PERC",32000100,CDM,320,RC,74475,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC INSERT INTRACATH OR CATH RENAL PELVIS, PERC",32000100,CDM,320,RC,74475,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC INSERT URETERAL CATH/STENT THRU RENAL PELV,32000101,CDM,320,RC,74480,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC DILATE URETER(S) OR URETHRA,32000102,CDM,320,RC,74485,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC HYSTEROSALPINGOGRAPHY S & I,32000103,CDM,320,RC,74740,HCPCS,facility,both,,,,789.2,789.2,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC HYSTEROSALPINGOGRAPHY S & I,32000103,CDM,320,RC,74740,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC SHUNTOGRAM FOR INDWELL NEUROVASC SHUNT,32000108,CDM,320,RC,75809,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC SHUNTOGRAM FOR INDWELL NEUROVASC SHUNT,32000108,CDM,320,RC,75809,HCPCS,facility,both,,,,591.9,591.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC VENOGRAPHY EXT UNILATERAL,32000109,CDM,320,RC,75820,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY EXT BILATERAL,32000110,CDM,320,RC,75822,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY CAVAL INFERIOR W/SERIALOGRAPHY,32000111,CDM,320,RC,75825,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY CAVAL SUPERIOR W/SERIALOGRAPH,32000112,CDM,320,RC,75827,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY RENAL UNILATERAL SELECTIVE,32000113,CDM,320,RC,75831,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY RENAL BILATERAL SELECTIVE,32000114,CDM,320,RC,75833,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY VENOUS SINUS/JUGULAR CATHETER,32000115,CDM,320,RC,75860,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOGRAPHY SUPERIOR SAGITTAL SINUS,32000116,CDM,320,RC,75870,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC PERCUT TRANSHEPATIC PORTOGRAM W/HDM,32000117,CDM,320,RC,75885,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC PERCUT TRANSHEPATIC PORTOGRAM W/O HDM,32000118,CDM,320,RC,75887,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC HEPATIC VENOGRAPHY W/ HDM,32000119,CDM,320,RC,75889,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC HEPATIC VENOGRAPHY W/O HDM,32000120,CDM,320,RC,75891,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VENOUS SAMPLING THRU CATH W/W/O ANGIO,32000121,CDM,320,RC,75893,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANSCATHETER THERAPY EMBOLIZATION,32000122,CDM,320,RC,75894,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANSCATHETER THERAPY INFUSION,32000123,CDM,320,RC,75896,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC ANGIO F/U TRANSCATH TX, EMBOLIZ/INFUSION",32000124,CDM,320,RC,75898,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC REMOVE OBSTRUCT FROM CENTRAL VENOUS DEV,32000126,CDM,320,RC,75901,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC REMOVE INTRALUMIN OBSTRUCT FROM CVD,32000127,CDM,320,RC,75902,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANSLUM BALLOON ANGIOPLAST PERPH ARTERY,32000131,CDM,320,RC,75962,HCPCS,facility,both,,,,58.61,58.61,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANS BALLOON ANGIOPLASTY EA + PER ARTERY,32000132,CDM,320,RC,75964,HCPCS,facility,both,,,,58.61,58.61,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANS BALLOON ANGIOPLAST RENAL/VISC ARTERY,32000133,CDM,320,RC,75966,HCPCS,facility,both,,,,58.61,58.61,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANS BALLOON ANGIOPLASTY EA + VISC ARTERY,32000134,CDM,320,RC,75968,HCPCS,facility,both,,,,58.61,58.61,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANSCATHETER BIOPSY,32000135,CDM,320,RC,75970,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS,32000136,CDM,320,RC,75978,HCPCS,facility,both,,,,58.61,58.61,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC PERC TRANSHEP BIL DRAINAGE W/CON MONITOR,32000137,CDM,320,RC,75980,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CHG PERC TUBE/ DRAIN CATH W/CON MONITOR,32000139,CDM,320,RC,75984,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID,32000140,CDM,320,RC,75989,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID,32000140,CDM,320,RC,75989,HCPCS,facility,both,,,,789.2,789.2,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID,32000140,CDM,320,RC,75989,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR,32000141,CDM,320,RC,76000,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR,32000141,CDM,320,RC,76000,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC FLUOROSCOPE EXAMINATION MORE THAN 1 HR,32000142,CDM,320,RC,76001,HCPCS,facility,both,,,,345.18,345.18,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FLUOROSCOPE EXAMINATION MORE THAN 1 HR,32000142,CDM,320,RC,76001,HCPCS,facility,both,,,,71.39,71.39,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RAD EX FISTULA OR SINUS TRACT STUDY S & I,32000143,CDM,320,RC,76080,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RAD EX FISTULA OR SINUS TRACT STUDY S & I,32000143,CDM,320,RC,76080,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM SURGICAL SPECIMEN,32000144,CDM,320,RC,76098,HCPCS,facility,both,,,,84.3,84.3,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FLUOROGUIDE CENTRAL VEN ACCESS DEV PLCMNT,32000146,CDM,320,RC,77001,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT,32000147,CDM,320,RC,77002,HCPCS,facility,both,,,,2367.6,2367.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT,32000147,CDM,320,RC,77002,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION,32000148,CDM,320,RC,77003,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION,32000148,CDM,320,RC,77003,HCPCS,facility,both,,,,2367.6,2367.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE",32000151,CDM,320,RC,77053,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC BONE AGE STUDIES,32000152,CDM,320,RC,77072,HCPCS,facility,both,,,,168.6,168.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC BONE LENGTH STUDIES,32000153,CDM,320,RC,77073,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM OSSEOUS SURVEY LIMITED,32000154,CDM,320,RC,77074,HCPCS,facility,both,,,,505.81,505.81,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM OSSEOUS SURVEY COMPLETE,32000155,CDM,320,RC,77075,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM OSSEOUS SURVEY INFANT,32000156,CDM,320,RC,77076,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DXA BONE DENSITY STUDY, AXIAL 1+ SITES",32000157,CDM,320,RC,77080,HCPCS,facility,both,,,,379.36,379.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DXA BONE DENSITY PERIPHERAL, AXIAL 1+ SITES",32000158,CDM,320,RC,77081,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC SELECTIVE ADRENAL VENOGRAM, BILATERAL",32000161,CDM,320,RC,75842,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC SELECTIVE ADRENAL VENOGRAM, UNILATERAL",32000162,CDM,320,RC,75840,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC X-RAY EXAM OF MASTOIDS 3+ VIEWS,32000200,CDM,320,RC,70130,HCPCS,facility,both,,,,421.5,421.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC TMJ JOINT - UNILATERAL,32000201,CDM,320,RC,70328,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; BENDING VIEWS ONLY, 2 OR 3 VIEWS",32000203,CDM,320,RC,72120,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM SACROILIAC JOINTS <3 VIEWS,32000204,CDM,320,RC,72200,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
DEAC 1/1/2022 HC EPIDUROGRAM,32000205,CDM,320,RC,72275,HCPCS,facility,both,,,,115.7,115.7,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC X-RAY EXAM OF FOOT; 2 VIEWS,32000206,CDM,320,RC,73620,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY",32000207,CDM,320,RC,74240,HCPCS,facility,both,,,,969.47,969.47,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; DBL STDY",32000208,CDM,320,RC,74246,HCPCS,facility,both,,,,1095.92,1095.92,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UGI W AIR & BARIUM W SB,32000209,CDM,320,RC,74249,HCPCS,facility,both,,,,1336.53,1336.53,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHOLANGIOGRAM ADDTL INTRAOP,32000210,CDM,320,RC,74301,HCPCS,facility,both,,,,394.6,394.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHOLANGIOGRAM ADDTL INTRAOP,32000210,CDM,320,RC,74301,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ENDO CATH - BIL & PANCR D,32000211,CDM,320,RC,74330,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ENDO CATH - BIL & PANCR D,32000211,CDM,320,RC,74330,HCPCS,facility,both,,,,1874.35,1874.35,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC IR ABD ANEURYSM REPAIR,32000213,CDM,320,RC,75952,HCPCS,facility,both,,,,102.78,102.78,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ILIAC ANEURYSM ENDOVAS RPR,32000214,CDM,320,RC,75953,HCPCS,facility,both,,,,102.78,102.78,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC NOSE TO RECTUM FOR FB CHILD,32000215,CDM,320,RC,76010,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM OF MASTOIDS <3 VIEWS,32000216,CDM,320,RC,70120,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY SELLA TURCICA,32000217,CDM,320,RC,70240,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY SPINE THORACOLUMBAR STANDING,32000219,CDM,320,RC,72069,HCPCS,facility,both,,,,295.95,295.95,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC CHOLECYSTOGRAPHY, ORAL CONTRAST",32000220,CDM,320,RC,74290,HCPCS,facility,both,,,,632.26,632.26,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC CHOLECYSTOGRAPHY, ORAL CONTRAST ADDL/2ND PROC",32000221,CDM,320,RC,74291,HCPCS,facility,both,,,,789.2,789.2,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC UROGRAPHY, INFUSION IVP, DRIP/BOLUS",32000223,CDM,320,RC,74410,HCPCS,facility,both,,,,1011.62,1011.62,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY STRESS VIEW,32000228,CDM,320,RC,77071,HCPCS,facility,both,,,,379.36,379.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC INTRALUMINAL DILATION OF STRICTURES/OBSTRUCTIONS,32000229,CDM,320,RC,74360,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC X-RAY OF MAMMARY DUCTS,32000235,CDM,320,RC,77054,HCPCS,facility,both,,,,632.26,632.26,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC XRAY EXAM, ENTIRE SPINE AP & LAT",32000240,CDM,320,RC,72010,HCPCS,facility,both,,,,887.85,887.85,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CINE/ VIDEO X-RAYS ADD-ON,32000251,CDM,320,RC,76125,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CINE/ VIDEO X-RAYS ADD-ON,32000251,CDM,320,RC,76125,HCPCS,facility,both,,,,758.71,758.71,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC JOINT SURVEY SINGLE VIEW 2+ JOINTS,32000252,CDM,320,RC,77077,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC VESSEL MAP FOR HEMODIALYSIS ACCESS,32000254,CDM,320,RC,,,facility,both,,,,1616.68,1616.68,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC LYMPHANGIOGRAM PELVIC/ABD; BILAT,32000255,CDM,320,RC,75807,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ILIAC ANEURYSM ENDOVAS RPR,32000256,CDM,320,RC,75954,HCPCS,facility,both,,,,102.78,102.78,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ART OCCLUSIVE DEVICE PLCMT,32000257,CDM,320,RC,,,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC VERTEBRAL FRACTURE ASSESSMENT VIA DXA,32000258,CDM,320,RC,77086,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM ENTIRE SPINE, 1 VW",32000262,CDM,320,RC,72081,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM ENTIRE SPINE,  2/3 VW",32000263,CDM,320,RC,72082,HCPCS,facility,both,,,,547.96,547.96,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM ENTIRE SPINE,  4/5 VW",32000264,CDM,320,RC,72083,HCPCS,facility,both,,,,590.11,590.11,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM ENTIRE SPINE,  6/> VW",32000265,CDM,320,RC,72084,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED,  1 VW",32000266,CDM,320,RC,73501,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 2-3 VW",32000267,CDM,320,RC,73502,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 4/> VW",32000268,CDM,320,RC,73503,HCPCS,facility,both,,,,421.5,421.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 2 VW",32000269,CDM,320,RC,73521,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 3-4 VW",32000270,CDM,320,RC,73522,HCPCS,facility,both,,,,379.36,379.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 5/> VW",32000271,CDM,320,RC,73523,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM OF FEMUR,  1 VIEW",32000272,CDM,320,RC,73551,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC X-RAY EXAM OF FEMUR,  2/> VIEWS",32000273,CDM,320,RC,73552,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC CINE/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIF INCL",32000275,CDM,320,RC,76120,HCPCS,facility,both,,,,758.71,758.71,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DXA BONE DENSITY STDY, 1+ SITES; AXIAL SKEL, INCL VERTEB FRACTURE ASSESS",32000276,CDM,320,RC,77085,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM ABDOMEN 1 VIEW,32000278,CDM,320,RC,74018,HCPCS,facility,both,,,,168.6,168.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM ABDOMEN 2 VIEWS,32000279,CDM,320,RC,74019,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM ABDOMEN 3 OR MORE VIEWS,32000280,CDM,320,RC,74021,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY,32000281,CDM,320,RC,74248,HCPCS,facility,both,,,,547.96,547.96,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DUPLEX SCAN ARTERIAL INFLOW & VENOUS OUTFLOW, PREOP, COMPLT BIL STUDY",32000282,CDM,921,RC,93985,HCPCS,facility,both,,,,2697.64,2697.64,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DUPLEX SCAN ARTERIAL INFLOW & VENOUS OUTFLOW, PREOP, COMPLT UNI STUDY",32000283,CDM,921,RC,93986,HCPCS,facility,both,,,,1559.57,1559.57,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SHOULDER, ARTHROGRAPHY",32200001,CDM,322,RC,73040,HCPCS,facility,both,,,,887.85,887.85,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM SHOULDER, ARTHROGRAPHY",32200001,CDM,322,RC,73040,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC RAD EXAM ELBOW, ARTHROGRAPHY",32200002,CDM,322,RC,73085,HCPCS,facility,both,,,,887.85,887.85,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RAD EXAM ELBOW, ARTHROGRAPHY",32200002,CDM,322,RC,73085,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RAD EXAM WRIST ARTHROGRAPHY,32200003,CDM,322,RC,73115,HCPCS,facility,both,,,,887.85,887.85,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM WRIST ARTHROGRAPHY,32200003,CDM,322,RC,73115,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RAD EXAM HIP ARTHROGRAPHY,32200004,CDM,322,RC,73525,HCPCS,facility,both,,,,887.85,887.85,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM HIP ARTHROGRAPHY,32200004,CDM,322,RC,73525,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RAD EXAM KNEE ARTHROGRAPHY,32200005,CDM,322,RC,73580,HCPCS,facility,both,,,,887.85,887.85,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RAD EXAM KNEE ARTHROGRAPHY,32200005,CDM,322,RC,73580,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RAD EXAM ANKLE ARTHROGRAPHY,32200006,CDM,322,RC,73615,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC AORTOGRAPHY THORACIC BY SERIALOGRAPHY,32300001,CDM,323,RC,75605,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC AORTOGRAPHY ABDOMINAL BY SERIALOGRAPHY,32300002,CDM,323,RC,75625,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC AORTOGRAM ABDOMINAL W/ BILATERAL RUNOFF,32300003,CDM,323,RC,75630,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY SPINAL SELECTIVE,32300012,CDM,323,RC,75705,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY EXT UNILATERAL S & I,32300013,CDM,323,RC,75710,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY EXT BILATERAL S & I,32300014,CDM,323,RC,75716,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY VISCERAL SELECT/SUPRASELECT,32300015,CDM,323,RC,75726,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY ADRENAL UNILATERAL SELECTIVE,32300016,CDM,323,RC,75731,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY ADRENAL BILATERAL SELECTIVE,32300017,CDM,323,RC,75733,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY PELVIC SELECT/SUPRASELECT,32300018,CDM,323,RC,75736,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY PULMONARY UNILAT SELECTIVE,32300019,CDM,323,RC,75741,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY PULMONARY BILAT  SELECTIVE,32300020,CDM,323,RC,75743,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY INTERNAL MAMMARY S & I,32300022,CDM,323,RC,75756,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC ANGIOGRAPHY SELECTIVE EA ADDTL VESSEL,32300023,CDM,323,RC,75774,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC RETROGRADE BRACHIAL ANGIOGRAM,32300025,CDM,323,RC,75658,HCPCS,facility,both,,,,102.78,102.78,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC AV DIALYSIS SHUNT IMAGING,32300052,CDM,323,RC,75791,HCPCS,facility,both,,,,58.61,58.61,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
"HC CHEST X-RAY SINGLE VIEW, POSTEROANTERIOR",32400001,CDM,324,RC,71010,HCPCS,facility,both,,,,141.36,141.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC CHEST X-RAY 2 VIEWS, FRONTAL AND LATERAL",32400002,CDM,324,RC,71020,HCPCS,facility,both,,,,176.7,176.7,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEST X-RAY 2 VIEWS W/APICAL LORDOTIC PROJ,32400003,CDM,324,RC,71021,HCPCS,facility,both,,,,212.04,212.04,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEST X-RAY 2 VIEWS W/OBLIQUE PROJECTION,32400004,CDM,324,RC,71022,HCPCS,facility,both,,,,247.38,247.38,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEST X-RAY COMPLETE MIN 4 VIEWS,32400005,CDM,324,RC,71030,HCPCS,facility,both,,,,217.63,217.63,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEST X-RAY MIN 4 VIEWS W/FLUORO,32400006,CDM,324,RC,71034,HCPCS,facility,both,,,,600.78,600.78,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEST X-RAY SPECIAL VIEW(LATERAL DECUBITUS),32400007,CDM,324,RC,71035,HCPCS,facility,both,,,,247.38,247.38,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RIBS X-RAY, UNILAT, MIN 3 VIEWS INCL CHEST",32400009,CDM,320,RC,71101,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC RIBS X-RAY, BILAT, MIN 4 VIEWS INCL CHEST",32400010,CDM,320,RC,71111,HCPCS,facility,both,,,,379.36,379.36,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC STERNUM X-RAY MIN 2 VIEWS,32400011,CDM,320,RC,71120,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS,32400012,CDM,320,RC,71130,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM OF RIBS 2 VIEWS UNILAT,32400020,CDM,320,RC,71100,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM OF RIBS 3 VIEWS BILAT,32400022,CDM,320,RC,71110,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEST X-RAY 2 VIEWS FR&LAT W FLUORO,32400024,CDM,324,RC,71023,HCPCS,facility,both,,,,424.08,424.08,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM CHEST 1 VIEW,32400025,CDM,324,RC,71045,HCPCS,facility,both,,,,168.6,168.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM CHEST 2 VIEWS,32400026,CDM,324,RC,71046,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM CHEST 3 VIEWS,32400027,CDM,324,RC,71047,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC X-RAY EXAM CHEST 4 OR MORE VIEWS,32400028,CDM,324,RC,71048,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL",33100001,CDM,331,RC,96401,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL",33100002,CDM,331,RC,96402,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL",33100003,CDM,331,RC,96409,HCPCS,facility,both,,,,660.54,660.54,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC CHEMOTHERAPY ADMIN, IVP EA ADDL",33100004,CDM,331,RC,96411,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC CHEMOTHERAPY ADMIN, CNS W/LP",33100005,CDM,331,RC,96450,HCPCS,facility,both,,,,656,656,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC THERA RAD SIMULATE-ADD FIELD SET, SIMPLE",33300001,CDM,333,RC,77280,HCPCS,facility,both,,,,388.01,388.01,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC THERA RAD SIMULATE-ADD FIELD SET, COMPLX",33300002,CDM,333,RC,77290,HCPCS,facility,both,,,,705.47,705.47,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC THERA RAD SIMULATE-ADD FIELD SET, 3D",33300003,CDM,333,RC,77295,HCPCS,facility,both,,,,435.04,435.04,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC BASIC RADIATION DOSIMETRY CALCULATION,33300004,CDM,333,RC,77300,HCPCS,facility,both,,,,52.91,52.91,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC INTENSITY MODULATED RADIOTHERAPY PLAN,33300005,CDM,333,RC,77301,HCPCS,facility,both,,,,2498.53,2498.53,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC SPECIAL DOSIMETRY,33300012,CDM,333,RC,77331,HCPCS,facility,both,,,,29.39,29.39,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC TREATMENT DEVICES SIMPLE,33300013,CDM,333,RC,77332,HCPCS,facility,both,,,,88.18,88.18,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC TREATMENT DEVICES INTERMEDIATE,33300014,CDM,333,RC,77333,HCPCS,facility,both,,,,117.58,117.58,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC TREATMENT DEVICES COMPLEX,33300015,CDM,333,RC,77334,HCPCS,facility,both,,,,146.97,146.97,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC QUALITY ASSURANCE CHECK FOR RADIATION THERAPY; PER WEEK BY MED TECHNICIAN,33300016,CDM,333,RC,77336,HCPCS,facility,both,,,,123.46,123.46,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC DESIGN MLC DEVICE FOR INTENSITY MOD RAD TX,33300017,CDM,333,RC,77338,HCPCS,facility,both,,,,464.43,464.43,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC SPECIAL MED RADIATION PHYSICS CONSULTATION,33300018,CDM,333,RC,77370,HCPCS,facility,both,,,,188.12,188.12,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC THERAPEUTIC RADIOLOGY PORT FILM(S),33300024,CDM,333,RC,77417,HCPCS,facility,both,,,,17.64,17.64,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC SPECIAL RADIATION TREATMENT,33300026,CDM,333,RC,77470,HCPCS,facility,both,,,,76.43,76.43,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC INFUSION/INSTILLATION RADIOELEMENT SOLUTION,33300027,CDM,333,RC,77750,HCPCS,facility,both,,,,182.25,182.25,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC INTRACAVITARY RAD SOURCE APPLICAT INTERMED,33300028,CDM,333,RC,77762,HCPCS,facility,both,,,,358.61,358.61,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC INTRACAVITARY RAD SOURCE APPLICAT COMPLEX,33300029,CDM,333,RC,77763,HCPCS,facility,both,,,,464.43,464.43,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC INTERSTITIAL RAD SOURCE APPLICATION COMPLEX,33300030,CDM,333,RC,77778,HCPCS,facility,both,,,,470.31,470.31,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC SUPERVISION, HANDLING, LOADING - RAD SOURCE",33300034,CDM,333,RC,77790,HCPCS,facility,both,,,,70.55,70.55,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC SIMULATION; INTERMEDIATE,33300050,CDM,333,RC,77285,HCPCS,facility,both,,,,611.4,611.4,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC HEMIBODY PARTICLES TOTAL BODY,33300052,CDM,333,RC,77321,HCPCS,facility,both,,,,70.55,70.55,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC SRS LINEAR BASED, 1 SESSION",33300073,CDM,333,RC,77372,HCPCS,facility,both,,,,1746.03,1746.03,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC SBRT DELIVERY PER FRACTION,33300074,CDM,333,RC,77373,HCPCS,facility,both,,,,2216.34,2216.34,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC GUIDANCE FOR RADIATION TX,33300076,CDM,333,RC,77387,HCPCS,facility,both,,,,117.58,117.58,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC TELETHERAPY ISODOSE PLAN, COMPLEX",33300077,CDM,333,RC,77307,HCPCS,facility,both,,,,217.52,217.52,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC BRACHYTHERAPY ISODOSE PLAN, SIMPLE",33300078,CDM,333,RC,77316,HCPCS,facility,both,,,,188.12,188.12,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC BRACHYTHERAPY ISODOSE PLAN, COMPLEX",33300080,CDM,333,RC,77318,HCPCS,facility,both,,,,329.22,329.22,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), SIMPLE",33300081,CDM,333,RC,77385,HCPCS,facility,both,,,,658.44,658.44,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), COMPLEX",33300082,CDM,333,RC,77386,HCPCS,facility,both,,,,658.44,658.44,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC TELETHERAPY ISODOSE PLAN, SIMPLE",33300083,CDM,333,RC,77306,HCPCS,facility,both,,,,117.58,117.58,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC RADIATION TREATMENT DELIVERY, =>1 MEV; SIMPLE",33300084,CDM,333,RC,77402,HCPCS,facility,both,,,,264.55,264.55,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE",33300085,CDM,333,RC,77407,HCPCS,facility,both,,,,423.28,423.28,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC RADIATION TREATMENT DELIVERY,=>1 MEV; COMPLEX",33300086,CDM,333,RC,77412,HCPCS,facility,both,,,,452.67,452.67,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 1 CHANNEL",33300087,CDM,333,RC,77770,HCPCS,facility,both,,,,270.43,270.43,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 2-12 CHANNELS",33300088,CDM,333,RC,77771,HCPCS,facility,both,,,,529.1,529.1,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, OVER 12 CHANNELS",33300089,CDM,333,RC,77772,HCPCS,facility,both,,,,864.2,864.2,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC TRNSPERNEAL PLCMNT BDGRDABL MATRL, PERI-PROSTATIC,  1+  INJ, W/IMAG",33300092,CDM,333,RC,55874,HCPCS,facility,both,,,,129.34,129.34,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
HC RESPIRATORY MOTION MGMT SIMULATION,33300098,CDM,333,RC,77293,HCPCS,facility,both,,,,593.77,593.77,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC CHEMOTHERAPY IV INFUSION, 1ST HR",33500001,CDM,335,RC,96413,HCPCS,facility,both,,,,1188.97,1188.97,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR",33500002,CDM,335,RC,96415,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ",33500003,CDM,335,RC,96417,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC CHEMO PROLONG 8+ HRS INFUSE W/PUMP,33500005,CDM,335,RC,96416,HCPCS,facility,both,,,,1188.97,1188.97,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC THYROID CARCINOMA METAST IMAG WHOLE BODY,34100004,CDM,341,RC,78018,HCPCS,facility,both,,,,1262.16,1262.16,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PARATHYROID IMAGING,34100005,CDM,341,RC,78070,HCPCS,facility,both,,,,1214.25,1214.25,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC ADRENAL IMAGING CORTEX AND/OR MEDULLA,34100006,CDM,341,RC,78075,HCPCS,facility,both,,,,1901.23,1901.23,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LYMPHATICS AND LYMPH NODE IMAGING,34100009,CDM,341,RC,78195,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LIVER IMAGING W VASCULAR FLOW,34100010,CDM,341,RC,78202,HCPCS,facility,both,,,,830.83,830.83,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LIVER IMAGING (SPECT),34100011,CDM,341,RC,78205,HCPCS,facility,both,,,,899.08,899.08,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LIVER IMAGING (SPECT) W/VASCULAR FLOW,34100012,CDM,341,RC,78206,HCPCS,facility,both,,,,1486.94,1486.94,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC HEPATOBILIARY SYSTEM IMAG INC GALLBLADDER,34100013,CDM,341,RC,78226,HCPCS,facility,both,,,,1374.02,1374.02,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC GASTROESOPHAGEAL REFLUX SCAN,34100014,CDM,341,RC,78262,HCPCS,facility,both,,,,974.58,974.58,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC GASTRIC EMPTYING STUDY, SOLID",34100015,CDM,341,RC,78264,HCPCS,facility,both,,,,1075.99,1075.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,34100018,CDM,341,RC,78278,HCPCS,facility,both,,,,1405.96,1405.96,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC INTESTINE IMAGING E.G. MECKEL'S LOCALIZATION,34100019,CDM,341,RC,78290,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PERITONEAL-VENOUS SHUNT PATENCY TEST,34100020,CDM,341,RC,78291,HCPCS,facility,both,,,,990.57,990.57,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC BONE AND/OR JOINT IMAGING, LIMITED AREA",34100021,CDM,341,RC,78300,HCPCS,facility,both,,,,702.98,702.98,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC BONE AND/OR JOINT IMAGING, WHOLE BODY",34100022,CDM,341,RC,78306,HCPCS,facility,both,,,,974.58,974.58,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC BONE AND/OR JOINT IMAGING , 3 PHASE STUDY",34100023,CDM,341,RC,78315,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC MYOCARD PERF IMAG SPECT SGL AT REST/STRESS,34100026,CDM,341,RC,78451,HCPCS,facility,both,,,,1278.16,1278.16,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC MYOCARD PERF IMAG SPECT MULTI  REST/STRESS,34100027,CDM,341,RC,78452,HCPCS,facility,both,,,,1837.33,1837.33,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC MYOCARD PERF IMAG PLANAR SGL REST/STRESS,34100028,CDM,341,RC,78453,HCPCS,facility,both,,,,1182.28,1182.28,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC CARDO BLD POOL IMAG PLANAR SNG REST/STRESS,34100029,CDM,341,RC,78472,HCPCS,facility,both,,,,846.76,846.76,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PULMONARY VENTILATION IMAG (AEROSOL/GAS),34100030,CDM,341,RC,78579,HCPCS,facility,both,,,,750.89,750.89,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PULMONARY PERFUSION IMAGING PARTICULATE,34100031,CDM,341,RC,78580,HCPCS,facility,both,,,,942.63,942.63,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PULMONARY VENTILATION & PERFUSION IMAGING,34100032,CDM,341,RC,78582,HCPCS,facility,both,,,,1310.08,1310.08,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BRAIN IMAGING TOMOGRAPHIC (SPECT),34100033,CDM,341,RC,78607,HCPCS,facility,both,,,,1486.94,1486.94,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BRAIN IMAGING VASCULAR FLOW ONLY,34100034,CDM,341,RC,78610,HCPCS,facility,both,,,,750.89,750.89,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC CEREBROSPINAL FLUID FLOW IMG CISTERNOGRAM,34100035,CDM,341,RC,78630,HCPCS,facility,both,,,,1421.94,1421.94,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC CEREBROSPINAL FLUID FLOW IMG SHUNT EVAL,34100036,CDM,341,RC,78645,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC CEREBROSPINAL FLUID LEAKAGE IMAGING,34100037,CDM,341,RC,78650,HCPCS,facility,both,,,,1405.96,1405.96,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY IMAGING W/VASC FLOW & FUNCTION,34100038,CDM,341,RC,78707,HCPCS,facility,both,,,,862.73,862.73,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY IMAGING W/VASC FLOW & FUNC W/DRUG,34100039,CDM,341,RC,78708,HCPCS,facility,both,,,,543.22,543.22,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY IMAGING TOMOGRAPHIC (SPECT),34100040,CDM,341,RC,78710,HCPCS,facility,both,,,,864.5,864.5,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY STUDY NON-IMAGING RADIOISOTOPIC,34100041,CDM,341,RC,78725,HCPCS,facility,both,,,,415.37,415.37,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC URETER REFLUX STUDY RADIOPHARM CYSTOGRAM,34100042,CDM,341,RC,78740,HCPCS,facility,both,,,,894.72,894.72,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC UNLISTED GU PROCEDURE DIAGNOSTIC NM,34100043,CDM,341,RC,78799,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCAL TUMOR; PLANAR, SINGLE AREA, SINGLE DAY IMG",34100044,CDM,341,RC,78800,HCPCS,facility,both,,,,1038.5,1038.5,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCAL TUMOR ; PLANAR, WHOLE BODY, SINGLE DAY IMG",34100045,CDM,341,RC,78802,HCPCS,facility,both,,,,1310.08,1310.08,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCAL TUMOR,  SPECT; SINGLE AREA , SINGLE DAY IMG",34100046,CDM,341,RC,78803,HCPCS,facility,both,,,,1342.07,1342.07,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCALIZE ABSCESS, WHOLE BODY",34100047,CDM,341,RC,78806,HCPCS,facility,both,,,,1469.65,1469.65,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LIVER & SPLEEN; STATIC ONLY,34100063,CDM,341,RC,78215,HCPCS,facility,both,,,,798.84,798.84,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LIVER & SPLEEN; W VASC FLOW,34100064,CDM,341,RC,78216,HCPCS,facility,both,,,,463.33,463.33,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC HEPATOBIL SYST IMAGE W/DRUG,34100065,CDM,341,RC,78227,HCPCS,facility,both,,,,1885.26,1885.26,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC ESOPHAGEAL MOTILITY,34100066,CDM,341,RC,78258,HCPCS,facility,both,,,,878.72,878.72,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BONE/JOINT; MULTI AREAS,34100068,CDM,341,RC,78305,HCPCS,facility,both,,,,894.72,894.72,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BONE/JOINT; SPECT (3D),34100070,CDM,341,RC,78320,HCPCS,facility,both,,,,830.83,830.83,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BRAIN IMAGE W/FLOW 4 + VIEWS,34100073,CDM,341,RC,78606,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC TESTICULAR IMAGING W/FLOW,34100074,CDM,341,RC,78761,HCPCS,facility,both,,,,830.83,830.83,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC TUMOR LOCAL; PLANAR, 2 + AREAS, 1+ DAYS IMG/SNGL AREA IMG 2+ DAYS",34100075,CDM,341,RC,78801,HCPCS,facility,both,,,,1134.33,1134.33,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC Radiopharmaceutical Localization, Tomographic (SPECT)",34100077,CDM,341,RC,78807,HCPCS,facility,both,,,,1469.65,1469.65,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC SALIVARY GLAND; W SERIAL IMAGES,34100080,CDM,341,RC,78231,HCPCS,facility,both,,,,479.31,479.31,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LUNG PERFUSION DIFFERENTIAL,34100085,CDM,341,RC,78597,HCPCS,facility,both,,,,782.84,782.84,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY IMAGING WITH FLOW,34100090,CDM,341,RC,78701,HCPCS,facility,both,,,,878.72,878.72,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BONE MARROW IMAGING; MULTIPLE AREAS,34100095,CDM,341,RC,78103,HCPCS,facility,both,,,,862.73,862.73,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LUNG PERFUSION & VENTILATION DIFFERENTIAL,34100115,CDM,341,RC,78598,HCPCS,facility,both,,,,1230.2,1230.2,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY IMAGING MORPHOLOGY,34100120,CDM,341,RC,78700,HCPCS,facility,both,,,,702.98,702.98,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC KIDNEY FLOW/FUNCT IMAGE-MULT W & W/O PHARM INTERV,34100125,CDM,341,RC,78709,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC TUMOR IMAGING WHOLE BODY 2+ DAYS,34100130,CDM,341,RC,78804,HCPCS,facility,both,,,,2396.52,2396.52,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC LOCALIZATION OF INFLAMMATORY PROCESS; LIMIT AREA,34100135,CDM,341,RC,78805,HCPCS,facility,both,,,,743.47,743.47,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BONE MARROW IMAGING; WHOLE BODY,34100136,CDM,341,RC,78104,HCPCS,facility,both,,,,974.58,974.58,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC THYROID UPTAKE MEASUREMENT,34100140,CDM,341,RC,78012,HCPCS,facility,both,,,,335.52,335.52,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC THYROID IMAGING W/BLOOD FLOW,34100141,CDM,341,RC,78013,HCPCS,facility,both,,,,798.84,798.84,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC THYROID IMAGING W/BLOOD FLOW & 1+ UPTAKES,34100142,CDM,341,RC,78014,HCPCS,facility,both,,,,1006.54,1006.54,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC HT MUSC IMAGE PLANAR MULT,34100150,CDM,341,RC,78454,HCPCS,facility,both,,,,1725.5,1725.5,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC MI PLANAR; SPECT (3D),34100151,CDM,341,RC,78469,HCPCS,facility,both,,,,846.76,846.76,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BM IMAGING; LIMITED,34100152,CDM,341,RC,78102,HCPCS,facility,both,,,,671.04,671.04,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC SALIVARY GLAND IMAGE;,34100153,CDM,341,RC,78230,HCPCS,facility,both,,,,702.98,702.98,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC SALIVARY GLAND FUNCTION,34100154,CDM,341,RC,78232,HCPCS,facility,both,,,,367.48,367.48,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC BRAIN IMAGE 4+ VIEWS,34100155,CDM,341,RC,78605,HCPCS,facility,both,,,,814.82,814.82,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCALIZE TUMOR, SPECT, W/CT 1 AREA 1 DAY IMAGE",34100157,CDM,341,RC,78830,HCPCS,facility,both,,,,1917.21,1917.21,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCAL TUMOR, SPECT, 2 AREA 1 DAY IMG OR 1 AREA IMG 2+ DAYS",34100158,CDM,341,RC,78831,HCPCS,facility,both,,,,2843.89,2843.89,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM LOCAL TUMOR, SPECT, MIN 2 AREA 1 DAY IMG /1 AREA OR IMG 2+ DAYS",34100159,CDM,341,RC,78832,HCPCS,facility,both,,,,3754.55,3754.55,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARMACEUTICAL QUANTIFICATION MEASUREMENT(S), 1 AREA",34100160,CDM,341,RC,78835,HCPCS,facility,both,,,,367.48,367.48,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC GASTRIC EMPTYING STUDY - LIQUID,34100200,CDM,341,RC,78264,HCPCS,facility,both,,,,707.08,707.08,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC MRA WO CONTRAST, PELVIS",34100201,CDM,618,RC,,,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC PARATHYRD PLANAR W/SPECT&CT,34100203,CDM,341,RC,78072,HCPCS,facility,both,,,,1565.72,1565.72,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC GASTRIC EMPTYING IMAGING STUDY  (SOLID, LIQUID OR BOTH)",34100205,CDM,341,RC,78264,HCPCS,facility,both,,,,1389.99,1389.99,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC GASTRIC EMPTYING IMAGING STUDY; W/SMALL BOWEL TRANSIT,34100206,CDM,341,RC,78265,HCPCS,facility,both,,,,1629.64,1629.64,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC GASTRIC EMPTYING IMAG STUDY W/SMALL BOWEL & COLON TRANSIT, MULT DAY",34100207,CDM,341,RC,78266,HCPCS,facility,both,,,,1965.17,1965.17,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM THERAPY, BY ORAL ADMINISTRATION",34200001,CDM,342,RC,79005,HCPCS,facility,both,,,,223.68,223.68,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC RADIOPHARM THERAPY, BY IV ADMINISTRATION",34200002,CDM,342,RC,79101,HCPCS,facility,both,,,,223.68,223.68,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC INTERST COLLOID RPHARM RX,34200050,CDM,342,RC,79300,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CT SOFT TISSUE NECK W/O CONTRAST,35000001,CDM,350,RC,70490,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT SOFT TISSUE NECK W/CONTRAST,35000002,CDM,350,RC,70491,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT SOFT TISSUE NECK W/O & W/CONTRAST,35000003,CDM,350,RC,70492,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ANGIO NECK W/CONTRAST MATERIAL(S),35000004,CDM,350,RC,70498,HCPCS,facility,both,,,,351.76,351.76,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT HEART W/O CONTRAST W/CALCIUM QUANT,35000005,CDM,350,RC,75571,HCPCS,facility,both,,,,123.43,123.43,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT HEART W/CONTRAST INC W/3 D POSTPROC,35000006,CDM,350,RC,75572,HCPCS,facility,both,,,,339.42,339.42,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT HEART W/CON FOR CONGENTIAL HEART DIS,35000007,CDM,350,RC,75573,HCPCS,facility,both,,,,456.68,456.68,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CTA HEART W/CON W/3D IMAGE POSTPROCESS,35000008,CDM,350,RC,75574,HCPCS,facility,both,,,,524.56,524.56,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC 3D RENDERING W/O POSTPROCESS,35000009,CDM,350,RC,76376,HCPCS,facility,both,,,,84.3,84.3,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC 3D RENDERING W/O POSTPROCESS,35000009,CDM,350,RC,76376,HCPCS,facility,both,,,,24.68,24.68,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC 3D RENDERING W POSTPROCESS,35000010,CDM,350,RC,76377,HCPCS,facility,both,,,,210.76,210.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC 3D RENDERING W POSTPROCESS,35000010,CDM,350,RC,76377,HCPCS,facility,both,,,,115.46,115.46,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC 3D RENDERING W POSTPROCESS,35000010,CDM,350,RC,76377,HCPCS,facility,both,,,,55.54,55.54,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC 3D RENDERING W POSTPROCESS,35000010,CDM,350,RC,76377,HCPCS,facility,both,,,,155.35,155.35,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CT LIMITED OR LOCALIZED FOLLOW-UP STUDY,35000011,CDM,350,RC,76380,HCPCS,facility,both,,,,166.63,166.63,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC UNLISTED CT PROCEDURE,35000012,CDM,350,RC,76497,HCPCS,facility,both,,,,246.85,246.85,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT SCAN FOR NEEDLE BIOPSY,35000013,CDM,350,RC,77012,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CT SCAN FOR NEEDLE BIOPSY,35000013,CDM,350,RC,77012,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT GUIDANCE TISSUE ABLATION,35000014,CDM,350,RC,77013,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC CT GUIDANCE PLCMNT RAD THERAPY FIELDS,35000015,CDM,350,RC,77014,HCPCS,facility,both,,,,117.58,117.58,,,,,,,,,,,,,Gross Charge Type: BMC 46 RADIATION ONC
"HC CT HEAD OR BRAIN, W/O CONTRAST",35100001,CDM,351,RC,70450,HCPCS,facility,both,,,,129.6,129.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT HEAD OR BRAIN, W CONTRAST",35100002,CDM,351,RC,70460,HCPCS,facility,both,,,,185.14,185.14,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT HEAD OR BRAIN, W & W/O CONTRAST",35100003,CDM,351,RC,70470,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT ORBIT, SELLA, POSTERIOR FOSSA W/O CONTRAST",35100004,CDM,351,RC,70480,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT ORBIT, SELLA, POSTERIOR FOSSA W CONTRAST",35100005,CDM,351,RC,70481,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT ORBIT, SELLA, P. FOSSA W/O & W CONTRAST",35100006,CDM,351,RC,70482,HCPCS,facility,both,,,,394.97,394.97,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT MAXILLOFACIAL W/O CONTRAST,35100007,CDM,351,RC,70486,HCPCS,facility,both,,,,166.63,166.63,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT MAXILLOFACIAL W/CONTRAST,35100008,CDM,351,RC,70487,HCPCS,facility,both,,,,191.31,191.31,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT MAXILLOFACIAL W/O & W/CONTRAST,35100009,CDM,351,RC,70488,HCPCS,facility,both,,,,246.85,246.85,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ANGIO HEAD W/CONTRAST MATERIAL(S),35100010,CDM,351,RC,70496,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC DX CT THORAX W/O CONTRAST,35200001,CDM,352,RC,71250,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC DX CT THORAX W CONTRAST,35200002,CDM,352,RC,71260,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC DX CT THORAX W & W/O CONTRAST,35200003,CDM,352,RC,71270,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CTA CHEST W CONTRAST,35200004,CDM,352,RC,71275,HCPCS,facility,both,,,,364.12,364.12,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT CERVICAL SPINE, W/O CONTRAST",35200005,CDM,352,RC,72125,HCPCS,facility,both,,,,228.34,228.34,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT CERVICAL SPINE, W CONTRAST",35200006,CDM,352,RC,72126,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT CERVICAL SPINE, W & W/O CONTRAST",35200007,CDM,352,RC,72127,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT  THORACIC SPINE, W/O CONTRAST",35200008,CDM,352,RC,72128,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT THORACIC SPINE, W CONTRAST",35200009,CDM,352,RC,72129,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT THORACIC SPINE, W & W/O CONTRAST",35200010,CDM,352,RC,72130,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT LUMBAR SPINE, W/O CONTRAST",35200011,CDM,352,RC,72131,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT  LUMBAR SPINE, W CONTRAST",35200012,CDM,352,RC,72132,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT LUMBAR SPINE, W & W/O CONTRAST",35200013,CDM,352,RC,72133,HCPCS,facility,both,,,,357.94,357.94,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CTA PELVIS W & W/O CONTRAST,35200014,CDM,352,RC,72191,HCPCS,facility,both,,,,370.29,370.29,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT PELVIS W/O CONTRAST,35200015,CDM,352,RC,72192,HCPCS,facility,both,,,,160.46,160.46,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT PELVIS W CONTRAST,35200016,CDM,352,RC,72193,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT PELVIS W & W/O CONTRAST,35200017,CDM,352,RC,72194,HCPCS,facility,both,,,,345.59,345.59,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT UPPER EXT W/O CONTRAST,35200019,CDM,352,RC,73200,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT UPPER EXT W CONTRAST,35200020,CDM,352,RC,73201,HCPCS,facility,both,,,,283.88,283.88,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CTA UPPER EXT W & W/O CONTRAST,35200021,CDM,352,RC,73206,HCPCS,facility,both,,,,413.48,413.48,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT LOWER EXT W/O CONTRAST,35200022,CDM,352,RC,73700,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT LOWER EXT W CONTRAST,35200023,CDM,352,RC,73701,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT LOWER EXT W & W/O CONTRAST,35200024,CDM,352,RC,73702,HCPCS,facility,both,,,,370.29,370.29,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CTA LOWER EXT W/O & W CONTRAST,35200025,CDM,352,RC,73706,HCPCS,facility,both,,,,450.51,450.51,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ABDOMEN W/O CONTRAST,35200026,CDM,352,RC,74150,HCPCS,facility,both,,,,154.29,154.29,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ABDOMEN W CONTRAST,35200027,CDM,352,RC,74160,HCPCS,facility,both,,,,290.05,290.05,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ABDOMEN W & W/O CONTRAST,35200028,CDM,352,RC,74170,HCPCS,facility,both,,,,333.25,333.25,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CTA ABDOMEN W/O AND W CONTRAST,35200029,CDM,352,RC,74175,HCPCS,facility,both,,,,376.46,376.46,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ABDOMEN AND PELVIS W/O CONTRAST,35200030,CDM,352,RC,74176,HCPCS,facility,both,,,,197.49,197.49,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ABDOMEN AND PELVIS W CONTRAST,35200031,CDM,352,RC,74177,HCPCS,facility,both,,,,382.63,382.63,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ABDOMEN AND PELVIS W & W/O CONTRAST,35200032,CDM,352,RC,74178,HCPCS,facility,both,,,,438.17,438.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT COLONOGRAPHY, DX W/2D, 3D W/O CON",35200033,CDM,352,RC,74261,HCPCS,facility,both,,,,635.65,635.65,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT COLONOGRAPHY, DX W/2D, 3D W/CONTRAST",35200034,CDM,352,RC,74262,HCPCS,facility,both,,,,728.22,728.22,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT COLONOGRAPHY, SCREENING W/2D, 3D",35200035,CDM,352,RC,74263,HCPCS,facility,both,,,,1110.85,1110.85,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ANGIO ABDOMINAL ARTERIES,35200040,CDM,352,RC,75635,HCPCS,facility,both,,,,456.68,456.68,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT UPR EXTREMITY W/WO CONTRAST,35200041,CDM,352,RC,73202,HCPCS,facility,both,,,,376.46,376.46,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC CT ANGIO ABD&PELV W/O&W/DYE,35200050,CDM,352,RC,74174,HCPCS,facility,both,,,,481.37,481.37,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC CT THORAX, LOW DOSE LUNG CANCER SCREENING, W/O CONTRAST",35200051,CDM,352,RC,71271,HCPCS,facility,both,,,,222.17,222.17,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC OR PROCEDURE PRICE PER MINUTE,36000001,CDM,360,RC,,,facility,both,,,,48.55,48.55,,,,,,,,,,,,,Gross Charge Type: BMC 40 OR
HC SDS - MINOR < 2 HOURS,36000010,CDM,360,RC,,,facility,both,,,,640.12,640.12,,,,,,,,,,,,,Gross Charge Type: BMC 33 SAME DAY SURGERY
HC SDS - MODERATE > 2 HRS AND <= 4 HRS,36000011,CDM,360,RC,,,facility,both,,,,1226.45,1226.45,,,,,,,,,,,,,Gross Charge Type: BMC 33 SAME DAY SURGERY
HC SDS - MAJOR > 4 HOURS,36000012,CDM,360,RC,,,facility,both,,,,2127.87,2127.87,,,,,,,,,,,,,Gross Charge Type: BMC 33 SAME DAY SURGERY
HC SDS - MAJOR DIAG. PROCEDURE > 6 HOURS,36000013,CDM,361,RC,,,facility,both,,,,2066.65,2066.65,,,,,,,,,,,,,Gross Charge Type: BMC 33 SAME DAY SURGERY
Operating Room Clinical Minutes,36100001,CDM,361,RC,,,facility,both,,,,48.03,48.03,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC IRC SURGICAL PRICE PER MINUTE,36100002,CDM,361,RC,,,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
DEAC 7/1/2017 HC RADIOLOGY SURGICAL COMPONENT,36100004,CDM,361,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, STEREOTACTIC GUIDANCE",36100006,CDM,361,RC,,,facility,both,,,,2367.6,2367.6,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"DEAC 7/1/2017 HC BREAST DEVICE LOC, PERCUTANEOUS, MAMMOGRAPHIC GUIDANCE",36100007,CDM,361,RC,,,facility,both,,,,1479.75,1479.75,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, MAGNETIC RESONANCE GUIDANCE",36100008,CDM,361,RC,36100008,HCPCS,facility,both,,,,1858.5,1858.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, ULTRASOUND GUIDANCE",36100009,CDM,361,RC,,,facility,both,,,,1479.75,1479.75,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"DEAC 7/1/2017 HC BREAST RAD EXAM, SURGICAL SPECIMEN",36100012,CDM,361,RC,,,facility,both,,,,295.95,295.95,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC RADIOACTIVE TRACER ID SENTINEL NODE,36100106,CDM,761,RC,38792,HCPCS,facility,both,,,,95.87,95.87,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC ARTERIAL BLOOD SAMPLING VIA PERC PUNCTURE,36100167,CDM,761,RC,36620,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC REPLACE NON-TUNNELED CV CATH,36100255,CDM,761,RC,,,facility,both,,,,492.01,492.01,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ANESTHESIOLOGY PRICE PER MINUTE,37000001,CDM,370,RC,,,facility,both,,,,8.98,8.98,,,,,,,,,,,,,Gross Charge Type: BMC 41 ANESTHESIOLOGY
HC L& D ANESTHESIA FLAT RATE,37000012,CDM,370,RC,,,facility,both,,,,91.89,91.89,,,,,,,,,,,,,Gross Charge Type: BMC 41 ANESTHESIOLOGY
HC RBC DEGLYCEROLIZED EACH UNIT,38100001,CDM,390,RC,,,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC DEGLYCEROLIZED EACH UNIT,38100001,CDM,390,RC,,,facility,both,,,,520,520,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC LR IRRADIATED EACH UNIT,38100003,CDM,390,RC,,,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC LR IRRADIATED EACH UNIT,38100003,CDM,390,RC,,,facility,both,,,,471.02,471.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC IRRADIATED EACH UNIT,38100005,CDM,390,RC,,,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WSH LR FROZ DW WB/RBC EA UNIT,38100006,CDM,390,RC,,,facility,both,,,,630,630,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WSH LR FROZ DW WB/RBC EA UNIT,38100006,CDM,390,RC,,,facility,both,,,,659.44,659.44,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC FROZ LEUK REDUC IRRAD EA UNIT,38100007,CDM,390,RC,,,facility,both,,,,790,790,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC FROZ LEUK REDUC IRRAD EA UNIT,38100007,CDM,390,RC,,,facility,both,,,,826.9,826.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-NEG LR IRRAD RBC EA UNIT,38100008,CDM,390,RC,,,facility,both,,,,512.89,512.89,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-NEG LR IRRAD RBC EA UNIT,38100008,CDM,390,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED),38100201,CDM,390,RC,,,facility,both,,,,770,770,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED),38100201,CDM,390,RC,,,facility,both,,,,805.97,805.97,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED),38100203,CDM,390,RC,,,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED),38100203,CDM,390,RC,,,facility,both,,,,700,700,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)",38100206,CDM,390,RC,,,facility,both,,,,921.12,921.12,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)",38100206,CDM,390,RC,,,facility,both,,,,630,630,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC FROZ LEUK REDUC IRRAD EA UNIT (AUTOLOGOUS/DIRECTED),38100207,CDM,390,RC,,,facility,both,,,,790,790,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WASHED RED BLOOD CELLS EA UNIT,38120004,CDM,390,RC,,,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WASHED RED BLOOD CELLS EA UNIT,38120004,CDM,390,RC,,,facility,both,,,,334.95,334.95,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WASHED RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED),38120005,CDM,390,RC,,,facility,both,,,,570,570,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WHOLE BLD FOR TRANSFUSION/UNIT,38200002,CDM,390,RC,,,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC WHOLE BLD FOR TRANSFUSION/UNIT,38200002,CDM,390,RC,,,facility,both,,,,282.61,282.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED),38200003,CDM,390,RC,,,facility,both,,,,544.29,544.29,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED),38200003,CDM,390,RC,,,facility,both,,,,520,520,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LR IRRAD WHOLE BLD EA UNIT,38200004,CDM,390,RC,,,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LR IRRAD WHOLE BLD EA UNIT,38200004,CDM,390,RC,,,facility,both,,,,540,540,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC WHOLE BLOOD, IRRADIATED, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)",38200204,CDM,390,RC,,,facility,both,,,,826.9,826.9,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FFP 8-24 HRS OF COLLECT EA UNIT,38300002,CDM,390,RC,,,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FFP 8-24 HRS OF COLLECT EA UNIT,38300002,CDM,390,RC,,,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DETERGENT TX FROZEN PLASMA EA UNIT,38300003,CDM,390,RC,,,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC DETERGENT TX FROZEN PLASMA EA UNIT,38300003,CDM,390,RC,,,facility,both,,,,251.22,251.22,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLATELETS PHERESIS EACH UNIT,38400001,CDM,390,RC,,,facility,both,,,,920,920,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PLATELETS PHERESIS EACH UNIT,38400001,CDM,390,RC,,,facility,both,,,,962.98,962.98,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLATELETS PHERESIS LR EA UNIT,38400002,CDM,390,RC,,,facility,both,,,,1046.72,1046.72,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLATELETS PHERESIS LR EA UNIT,38400002,CDM,390,RC,,,facility,both,,,,1000,1000,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PLATELETS PHERESIS LR IRRAD EA UNIT,38400003,CDM,390,RC,,,facility,both,,,,1160,1160,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PLATELETS PHERESIS LR IRRAD EA UNIT,38400003,CDM,390,RC,,,facility,both,,,,1214.19,1214.19,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC IRRADIATED PLATELETS EA UNIT,38400006,CDM,390,RC,,,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC IRRADIATED PLATELETS EA UNIT,38400006,CDM,390,RC,,,facility,both,,,,136.07,136.07,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKOREDUCED IRRAD PLATELETS EA UNIT,38400007,CDM,390,RC,,,facility,both,,,,146.54,146.54,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKOREDUCED IRRAD PLATELETS EA UNIT,38400007,CDM,390,RC,,,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PLTLT HLA-LR EA UNIT,38400008,CDM,390,RC,,,facility,both,,,,1250,1250,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PLTLT HLA-LR EA UNIT,38400008,CDM,390,RC,,,facility,both,,,,1308.4,1308.4,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-N LR IR PLTLT EA UNIT,38400009,CDM,390,RC,,,facility,both,,,,1256.06,1256.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-N LR IR PLTLT EA UNIT,38400009,CDM,390,RC,,,facility,both,,,,1200,1200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LR CMV-NEG PLATELETS EA UNIT,38400010,CDM,390,RC,,,facility,both,,,,1040,1040,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LR CMV-NEG PLATELETS EA UNIT,38400010,CDM,390,RC,,,facility,both,,,,1088.58,1088.58,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKO REDUCED PLATELETS EA UNIT,38400012,CDM,390,RC,,,facility,both,,,,125.61,125.61,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKO REDUCED PLATELETS EA UNIT,38400012,CDM,390,RC,,,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC PRT PLATELETS,38460001,CDM,390,RC,,,facility,both,,,,732.7,732.7,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PRT PLATELETS,38460001,CDM,390,RC,,,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC GRANULOCYTES PHERESIS UNIT,38600001,CDM,390,RC,,,facility,both,,,,1256.06,1256.06,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC GRANULOCYTES PHERESIS UNIT,38600001,CDM,390,RC,,,facility,both,,,,1200,1200,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC COMPATIBILITY TEST SPIN,39000001,CDM,300,RC,86920,HCPCS,facility,both,,,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC COMPATIBILITY TEST SPIN,39000001,CDM,300,RC,86920,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC BLOOD SPLIT UNIT,39000003,CDM,390,RC,,,facility,both,,,,230.28,230.28,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC BLOOD SPLIT UNIT,39000003,CDM,390,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CRYOPRECIPITATE EA UNIT,39000004,CDM,390,RC,,,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC CRYOPRECIPITATE EA UNIT,39000004,CDM,390,RC,,,facility,both,,,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKOCYTE POOR BLOOD EA UNIT,39000005,CDM,390,RC,,,facility,both,,,,290,290,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEUKOCYTE POOR BLOOD EA UNIT,39000005,CDM,390,RC,,,facility,both,,,,303.55,303.55,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLASMA 1 DONOR FRZ W/IN 8 HR,39000006,CDM,390,RC,,,facility,both,,,,83.74,83.74,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLASMA 1 DONOR FRZ W/IN 8 HR,39000006,CDM,390,RC,,,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RED BLOOD CELLS EA UNIT,39000007,CDM,390,RC,,,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RED BLOOD CELLS EA UNIT,39000007,CDM,390,RC,,,facility,both,,,,188.41,188.41,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-N LR WB/RBC EA UNIT,39000008,CDM,390,RC,,,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-N LR WB/RBC EA UNIT,39000008,CDM,390,RC,,,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT",39000009,CDM,390,RC,,,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT",39000009,CDM,390,RC,,,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC PLATELETS, EACH UNIT",39000010,CDM,390,RC,,,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLATELET PHERESIS IRRAD EA UNIT,39000011,CDM,390,RC,,,facility,both,,,,1130.45,1130.45,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PLATELET PHERESIS IRRAD EA UNIT,39000011,CDM,390,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC IRRADIATED EACH UNIT,39000012,CDM,390,RC,,,facility,both,,,,340,340,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RBC IRRADIATED EACH UNIT,39000012,CDM,390,RC,,,facility,both,,,,355.88,355.88,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC RBC LR,CMV NEG, IRR A/D",39000013,CDM,390,RC,,,facility,both,,,,753.64,753.64,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC RBC LR,CMV NEG, IRR A/D",39000013,CDM,390,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED),39000205,CDM,390,RC,,,facility,both,,,,565.23,565.23,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED),39000205,CDM,390,RC,,,facility,both,,,,540,540,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED),39000206,CDM,390,RC,,,facility,both,,,,345.42,345.42,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED),39000206,CDM,390,RC,,,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED),39000207,CDM,390,RC,,,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED),39000207,CDM,390,RC,,,facility,both,,,,450.09,450.09,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
"HC RBC, IRRADIATED  (AUTOLOGOUS/DIRECTED)",39000212,CDM,390,RC,,,facility,both,,,,340,340,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC RBC, IRRADIATED  (AUTOLOGOUS/DIRECTED)",39000212,CDM,390,RC,,,facility,both,,,,617.57,617.57,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-N LR WB/RBC AUT/DIR,39000213,CDM,390,RC,,,facility,both,,,,607.1,607.1,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC CMV-N LR WB/RBC AUT/DIR,39000213,CDM,390,RC,,,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE
"HC FFP HIGH TITER COVID-19 CONVALESCENT, FROZEN - 8 HR COLLECT, EA UNIT (439)",39000216,CDM,390,RC,,,facility,both,,,,919.02,919.02,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC TRANSFUSION BLOOD OR BLOOD COMPONENTS,39100001,CDM,391,RC,36430,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT",40100001,CDM,401,RC,,,facility,both,,,,264.67,264.67,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, UNILAT",40100002,CDM,401,RC,,,facility,both,,,,189.05,189.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL",40100003,CDM,401,RC,,,facility,both,,,,1201.56,1201.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DIAG  MAMMO, INCL CAD WHEN PERFORMED, UNIL",40100004,CDM,401,RC,,,facility,both,,,,918.84,918.84,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC COMPUTER DX MAMMOGRAM ADD-ON,40100010,CDM,401,RC,77051,HCPCS,facility,both,,,,37.81,37.81,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC MAMMOGRAM ONE BREAST,40100011,CDM,401,RC,77055,HCPCS,facility,both,,,,189.05,189.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC MAMMOGRAPHY BILATERAL,40100012,CDM,401,RC,77056,HCPCS,facility,both,,,,264.67,264.67,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL,40100014,CDM,401,RC,77061,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL,40100015,CDM,401,RC,77062,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DX MAMMO INCL CAD; UNILAT,40100016,CDM,401,RC,77065,HCPCS,facility,both,,,,1095.92,1095.92,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DX MAMMO INCL CAD; BILAT,40100017,CDM,401,RC,77066,HCPCS,facility,both,,,,1433.12,1433.12,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DIAGNOSTIC DIGITAL BREAST TOMOGRAPHY, UNILATERAL OR BILATERAL",40100018,CDM,401,RC,,,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ECHOENCEPHALOGRAPHY OF NEONATAL,40200001,CDM,402,RC,76506,HCPCS,facility,both,,,,1011.62,1011.62,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC ULTRASOUND, SOFT TISSUES HEAD & NECK",40200002,CDM,402,RC,76536,HCPCS,facility,both,,,,1053.76,1053.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND CHEST INCLS MEDIASTINUM,40200003,CDM,402,RC,76604,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND ABDOMEN COMPLETE,40200005,CDM,402,RC,76700,HCPCS,facility,both,,,,969.47,969.47,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC ULTRASOUND ABDOMEN LIMITED - 1 ORGAN, QUAD",40200006,CDM,402,RC,76705,HCPCS,facility,both,,,,758.71,758.71,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND RETROPERITONEAL COMPLETE,40200007,CDM,402,RC,76770,HCPCS,facility,both,,,,927.31,927.31,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND RETROPERITONEAL LIMITED,40200008,CDM,402,RC,76775,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND TRANSPLANTED KIDNEY W/DOPPLER,40200009,CDM,402,RC,76776,HCPCS,facility,both,,,,1433.12,1433.12,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND SPINAL CANAL AND CONTENTS,40200010,CDM,402,RC,76800,HCPCS,facility,both,,,,969.47,969.47,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, SINGLE FETUS < 14 WKS, TRANSABD APPRCH",40200011,CDM,402,RC,76801,HCPCS,facility,both,,,,885.16,885.16,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, FETUS < 14 WKS, EACH ADDTL FETUS",40200012,CDM,402,RC,76802,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, SINGLE FETUS > = 14 WKS, TRANSABD APPRCH",40200013,CDM,402,RC,76805,HCPCS,facility,both,,,,847.79,847.79,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC US, SINGLE FETUS > = 14 WKS, TRANSABD APPRCH",40200013,CDM,402,RC,76805,HCPCS,facility,both,,,,1095.92,1095.92,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, FETUS > = 14 WKS, EACH ADDTL FETUS",40200014,CDM,402,RC,76810,HCPCS,facility,both,,,,505.81,505.81,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, DETAILED FETAL ANATOMIC EXM, SNGL FETUS",40200015,CDM,402,RC,76811,HCPCS,facility,both,,,,1011.62,1011.62,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, DETAILED FETAL ANATOMIC EXM, ADDL FETUS",40200016,CDM,402,RC,76812,HCPCS,facility,both,,,,1348.82,1348.82,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US, NUCHAL TRANSLUCENCY MEASURE, 1 FETUS",40200017,CDM,402,RC,76813,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US NUCHAL TRANSLUCENCY MEASURE,ADDL FETUS",40200018,CDM,402,RC,76814,HCPCS,facility,both,,,,337.21,337.21,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US LIMITED 1 OR MORE FETUS(S),40200019,CDM,402,RC,76815,HCPCS,facility,both,,,,632.26,632.26,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US LIMITED 1 OR MORE FETUS(S),40200019,CDM,402,RC,76815,HCPCS,facility,both,,,,282.6,282.6,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC US FOLLOW-UP PER FETUS,40200020,CDM,402,RC,76816,HCPCS,facility,both,,,,843.02,843.02,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US OB TRANSVAGINAL,40200021,CDM,402,RC,76817,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FETAL BP PROFILE W/O NON-STRESS TEST,40200022,CDM,402,RC,76819,HCPCS,facility,both,,,,1130.39,1130.39,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC FETAL BP PROFILE W/O NON-STRESS TEST,40200022,CDM,402,RC,76819,HCPCS,facility,both,,,,590.11,590.11,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DOPPLER VELOCIMETRY, FETAL UMB ARTERY",40200023,CDM,402,RC,76820,HCPCS,facility,both,,,,252.9,252.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC DOPPLER VELOCIMETRY, FETAL UMB ARTERY",40200023,CDM,402,RC,76820,HCPCS,facility,both,,,,282.6,282.6,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY",40200024,CDM,402,RC,76821,HCPCS,facility,both,,,,674.41,674.41,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ECHOCARDIO FETAL CARDIOVASCULAR W/2-D,40200025,CDM,483,RC,76825,HCPCS,facility,both,,,,2318.28,2318.28,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ECHOCARDIO FETAL CARDIOVASCULAR F/U STUDY,40200026,CDM,483,RC,76826,HCPCS,facility,both,,,,1475.28,1475.28,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DOPPLER ECHOCARDIOLOGY FETAL COMPLETE,40200027,CDM,483,RC,76827,HCPCS,facility,both,,,,547.96,547.96,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DOPPLER ECHOCARDIOLOGY FETAL F/U,40200028,CDM,483,RC,76828,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC ULTRASOUND TRANSVAGINAL, NON OB",40200029,CDM,402,RC,76830,HCPCS,facility,both,,,,1053.76,1053.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND PELVIC EXAM COMPLETE NON OB,40200030,CDM,402,RC,76856,HCPCS,facility,both,,,,885.16,885.16,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND PELVIC EXAM LIMITED NON OB,40200031,CDM,402,RC,76857,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND SCROTUM AND CONTRASTENTS,40200032,CDM,402,RC,76870,HCPCS,facility,both,,,,421.5,421.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC ULTRASOUND TRANSRECTAL,40200033,CDM,402,RC,76872,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US TRANSRECTAL-PROSTATE VOL STUDY, BRACHY",40200034,CDM,402,RC,76873,HCPCS,facility,both,,,,1095.92,1095.92,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US COMPLETE JOINT,40200035,CDM,402,RC,76881,HCPCS,facility,both,,,,1053.76,1053.76,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC US LIMITED, JOINT OR FOCAL EVAL OF OTHER NONVASCULAR EXTREMITY STRUCTURE(S)",40200036,CDM,402,RC,76882,HCPCS,facility,both,,,,126.45,126.45,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US INFANT HIPS; LIMITED/STATIC,40200037,CDM,402,RC,76886,HCPCS,facility,both,,,,927.31,927.31,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDANCE PERICARDIOCENTESIS,40200038,CDM,402,RC,76930,HCPCS,facility,both,,,,94.18,94.18,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDANCE VASCULAR ACCESS,40200039,CDM,402,RC,76937,HCPCS,facility,both,,,,2959.5,2959.5,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDANCE VASCULAR ACCESS,40200039,CDM,402,RC,76937,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDANCE TISSUE ABLATION,40200040,CDM,402,RC,76940,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDANCE TISSUE ABLATION,40200040,CDM,402,RC,76940,HCPCS,facility,both,,,,789.2,789.2,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDED FETAL TRANSFUSION/CORDOCENTESIS,40200041,CDM,402,RC,76941,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDED NEEDLE PLACEMENT,40200042,CDM,402,RC,76942,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDED NEEDLE PLACEMENT,40200042,CDM,402,RC,76942,HCPCS,facility,both,,,,1479.75,1479.75,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDED CHORIONIC VILLUS SAMPLING,40200043,CDM,402,RC,76945,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDED AMNIOCENTESIS,40200044,CDM,402,RC,76946,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDED AMNIOCENTESIS,40200044,CDM,402,RC,76946,HCPCS,facility,both,,,,1183.8,1183.8,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDED INTERSTITIAL RADIOELEMENT APPLIC,40200046,CDM,402,RC,76965,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDANCE INTRAOPERATIVE,40200047,CDM,402,RC,76998,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UNLISTED ULTRASOUND PROCEDURE,40200048,CDM,402,RC,76999,HCPCS,facility,both,,,,493.25,493.25,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FETAL BP PROFILE W NON-STRESS TEST,40200049,CDM,402,RC,76818,HCPCS,facility,both,,,,843.02,843.02,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC FETAL BP PROFILE W NON-STRESS TEST,40200049,CDM,402,RC,76818,HCPCS,facility,both,,,,1412.99,1412.99,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC SALINE INFUSED SONOHYSTEROGRAM,40200050,CDM,402,RC,76831,HCPCS,facility,both,,,,1183.8,1183.8,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC SALINE INFUSED SONOHYSTEROGRAM,40200050,CDM,402,RC,76831,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US INFANT HIPS; DYNAMIC,40200051,CDM,402,RC,76885,HCPCS,facility,both,,,,1306.67,1306.67,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDED PSA/AVF COMPRESSION REPAIR,40200053,CDM,402,RC,76936,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDED PSA/AVF COMPRESSION REPAIR,40200053,CDM,402,RC,76936,HCPCS,facility,both,,,,1677.05,1677.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DX OPHTHALMIC US QUAN A-SCAN,40200055,CDM,402,RC,76511,HCPCS,facility,both,,,,590.11,590.11,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DX OPHTHAL B-SCAN US,40200056,CDM,402,RC,76512,HCPCS,facility,both,,,,463.66,463.66,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CORNEAL US,40200057,CDM,402,RC,76514,HCPCS,facility,both,,,,42.15,42.15,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC EYE BIOMETRY BY US A-SCAN;,40200058,CDM,402,RC,76516,HCPCS,facility,both,,,,547.96,547.96,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC A-SCAN EYE US W IOL MEASR,40200059,CDM,402,RC,76519,HCPCS,facility,both,,,,632.26,632.26,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC US GUIDE -  ENDOMYOCARDIAL BX,40200061,CDM,402,RC,76932,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC US GUIDE -  ENDOMYOCARDIAL BX,40200061,CDM,402,RC,76932,HCPCS,facility,both,,,,1973,1973,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC ULTRASOUND BREAST UNILAT, COMPLETE",40200062,CDM,402,RC,76641,HCPCS,facility,both,,,,843.02,843.02,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC ULTRASOUND BREAST UNILAT, LIMITED",40200063,CDM,402,RC,76642,HCPCS,facility,both,,,,632.26,632.26,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DX OPHTHALMIC US ANT SEGMENT IMMERSION UNIL OR BILAT,40200064,CDM,402,RC,76513,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC ULTRASOUND, ELASTOGRAPHY; PARENCHYMA (EG, ORGAN)",40200068,CDM,402,RC,76981,HCPCS,facility,both,,,,758.71,758.71,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC SCREENING MAMMOGRAPHY, BILAT 2 V EA BREAST",40300001,CDM,403,RC,77057,HCPCS,facility,both,,,,189.05,189.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC COMP SCREEN MAMMOGRAM ADD-ON,40300005,CDM,403,RC,77052,HCPCS,facility,both,,,,37.81,37.81,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC SCREENING MAMMOGRAPHY, DIGITAL, BILATERAL",40300006,CDM,403,RC,,,facility,both,,,,189.05,189.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC SCREENING DIGITAL BREAST TOMOSYNTHESIS; BILATERAL,40300007,CDM,403,RC,77063,HCPCS,facility,both,,,,295.05,295.05,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC SCREEN MAMMO INCL CAD; BILAT,40300008,CDM,403,RC,77067,HCPCS,facility,both,,,,1180.22,1180.22,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC SCREENING MAMMO, INCL CAD WHEN PERFORMED, BIL",40300009,CDM,403,RC,,,facility,both,,,,989.52,989.52,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC MYOCARD PERF IMAG PET, METABOLIC EVAL",40400001,CDM,404,RC,78459,HCPCS,facility,both,,,,11503.31,11503.31,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC MYCARDO IMAG PET PERF MULT REST/STRESS,40400002,CDM,404,RC,78492,HCPCS,facility,both,,,,7189.57,7189.57,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC BRAIN IMAGING, PET, METABOLIC EVALUATION",40400003,CDM,404,RC,78608,HCPCS,facility,both,,,,5751.65,5751.65,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC PET IMAGING, WHOLE BODY",40400004,CDM,404,RC,78813,HCPCS,facility,both,,,,7189.57,7189.57,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PET IMAGING W/CT SKULL BASE TO MID-THIGH,40400005,CDM,404,RC,78815,HCPCS,facility,both,,,,6949.93,6949.93,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PET IMAGING W/CT WHOLE BODY,40400006,CDM,404,RC,78816,HCPCS,facility,both,,,,7908.54,7908.54,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC PET IMAGE W/CT LMTD AREA,40400007,CDM,404,RC,78814,HCPCS,facility,both,,,,5751.65,5751.65,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
HC CARD PET PERFUS; SINGLE,40400016,CDM,404,RC,78491,HCPCS,facility,both,,,,3834.43,3834.43,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC PET IMAGING; LIMITED AREA (EG; CHEST, HEAD/NECK)",40400017,CDM,404,RC,78811,HCPCS,facility,both,,,,4313.73,4313.73,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"HC MYOCARDIAL IMG, PET, METABOLIC  EVAL, 1 STUDY CONCURRENT CT",40400018,CDM,404,RC,78429,HCPCS,facility,both,,,,11503.31,11503.31,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
DEAC 4/1/2020 HC CDSM APPLIED PATHWAYS,40920000,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM EVICORE,40920001,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM MEDCURRENT,40920002,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM MEDICALIS,40920003,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM NATIONAL DECISION SUPPORT COMPANY,40920004,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
HC DEAC 01/01/2021 CDSM NATIONAL IMAGING ASSOCIATES,40920005,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
HC DEAC 01/01/2021  CDSM TEST APPROPRIATE,40920006,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM AIM SPECIALTY HEALTH,40920007,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM CRANBERRY PEAK,40920008,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 04/01/2022 HC CDSM SAGE HELATH MANAGEMENT SOLUTIONS,40920009,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM STANSON,40920010,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM QUALIFIED TOOL NOT OTHERWISE SPECIFIED,40920011,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM AGILEMD,40920012,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM EVIDENCE CARE,40920013,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM INVENI QA,40920014,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM RELIANT MEDICAL GROUP,40920015,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM SPEED OF CARE,40920016,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM HEALTH'S HELP,40920017,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM INFINIX,40920018,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
DEAC 06/11/2024 HC CDSM LOGICNETS AUC SOLUTION,40920019,CDM,409,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11
"HC ENDOTRACHEAL, INTUBATION EMERGENCY",41000001,CDM,410,RC,31500,HCPCS,facility,both,,,,96.68,96.68,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC CATHETER ASPIRATION: NASOTRACHEAL,41000002,CDM,410,RC,31720,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC ARTERIAL PUNCTURE BLOOD FOR DX,41000005,CDM,410,RC,36600,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC ARTERIAL PUNCTURE BLOOD FOR DX,41000005,CDM,410,RC,36600,HCPCS,facility,both,,,,337.4,337.4,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY < 12 HRS",41000007,CDM,410,RC,94002,HCPCS,facility,both,,,,310.8,310.8,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY > 12 HRS",41000008,CDM,410,RC,94002,HCPCS,facility,both,,,,532.8,532.8,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC VENTILATOR MGT, INITIAL DAY NICU < 12 HRS",41000009,CDM,410,RC,94002,HCPCS,facility,both,,,,461.76,461.76,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018  HC VENTILATOR MGT, INITIAL DAY NICU > 12 HRS",41000010,CDM,410,RC,94002,HCPCS,facility,both,,,,834.72,834.72,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY < 12 HRS",41000011,CDM,410,RC,94003,HCPCS,facility,both,,,,277.5,277.5,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018  HC VENTILATOR MGT, SUBSEQ DAY > 12 HRS",41000012,CDM,410,RC,94003,HCPCS,facility,both,,,,466.2,466.2,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU < 12 HRS",41000013,CDM,410,RC,94003,HCPCS,facility,both,,,,461.76,461.76,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU > 12 HRS",41000014,CDM,410,RC,94003,HCPCS,facility,both,,,,834.72,834.72,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INHALATION TX, CONT NEB W/BROCH, INITIAL DAY",41000017,CDM,410,RC,94640,HCPCS,facility,both,,,,106.56,106.56,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INHALATION TX, CONT NEB W/BROCH, SUBSEQ DAY",41000018,CDM,410,RC,94640,HCPCS,facility,both,,,,33.3,33.3,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, INITIAL TREATMENT",41000019,CDM,410,RC,94640,HCPCS,facility,both,,,,66.6,66.6,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, SUBSEQ TREATMENT",41000020,CDM,410,RC,94640,HCPCS,facility,both,,,,33.3,33.3,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INHALATION TX, MDI, INITIAL DAY",41000023,CDM,410,RC,94640,HCPCS,facility,both,,,,88.8,88.8,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INHALATION TX, MDI, SUBSEQ DAY",41000024,CDM,410,RC,94640,HCPCS,facility,both,,,,55.5,55.5,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC AEROSOL PENTAMIDINE FOR P. CARINII,41000026,CDM,410,RC,94642,HCPCS,facility,both,,,,232.03,232.03,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY < 12 HRS",41000027,CDM,410,RC,94660,HCPCS,facility,both,,,,188.7,188.7,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY < 12 HRS",41000028,CDM,410,RC,94660,HCPCS,facility,both,,,,244.2,244.2,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY > 12 HRS",41000029,CDM,410,RC,94660,HCPCS,facility,both,,,,321.9,321.9,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY > 12 HRS",41000030,CDM,410,RC,94660,HCPCS,facility,both,,,,377.4,377.4,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC EVALUATE PT USE OF INHALER/PER DAY,41000031,CDM,410,RC,94664,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, INITIAL TX",41000032,CDM,410,RC,94667,HCPCS,facility,both,,,,77.7,77.7,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, INITIAL TX",41000032,CDM,410,RC,94667,HCPCS,facility,both,,,,1292.98,1292.98,,,,,,,,,,,,,Gross Charge Type: BMC 47 NUC MED
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, SUBSEQ TX",41000034,CDM,410,RC,94668,HCPCS,facility,both,,,,55.5,55.5,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC RT COMPREHENSIVE ASSESSMENT - INPATIENT, PER DAY",41000036,CDM,410,RC,,,facility,both,,,,55.24,55.24,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC MECHANICAL CHEST WALL OSCILLATION,41000037,CDM,410,RC,94669,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC ECMO/ECLS INITIATION VENOUS - DAILY MGMT,41000038,CDM,410,RC,33946,HCPCS,facility,both,,,,7038.01,7038.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC ECMO/ECLS INITIATION ARTERY - DAILY MGMT,41000039,CDM,410,RC,33947,HCPCS,facility,both,,,,7038.01,7038.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC ECMO/ECLS DAILY MGMT-VENOUS,41000040,CDM,410,RC,33948,HCPCS,facility,both,,,,5568.53,5568.53,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC ECMO/ECLS DAILY MGMT ARTERY,41000041,CDM,410,RC,33949,HCPCS,facility,both,,,,5568.53,5568.53,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC VENTILATOR MGT, INITIAL DAY - ADULT",41000042,CDM,410,RC,94002,HCPCS,facility,both,,,,966.76,966.76,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC VENTILATOR MGT, INITIAL DAY - NICU",41000043,CDM,410,RC,94002,HCPCS,facility,both,,,,1160.12,1160.12,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC VENTILATOR MGT, SUBSEQ DAY - ADULT",41000044,CDM,410,RC,94003,HCPCS,facility,both,,,,966.76,966.76,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC VENTILATOR MGT, SUBSEQ DAY - NICU",41000045,CDM,410,RC,94003,HCPCS,facility,both,,,,1160.12,1160.12,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC AIRWAY INHALATION TX - INPATIENT ADMISSION,41000046,CDM,410,RC,94640,HCPCS,facility,both,,,,1856.18,1856.18,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC AIRWAY INHALATION TX - OUTPATIENT ENCOUNTER,41000047,CDM,410,RC,94640,HCPCS,facility,both,,,,154.68,154.68,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC POS AIRWAY PRESSURE CPAP, PER DAY",41000048,CDM,410,RC,94660,HCPCS,facility,both,,,,464.04,464.04,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CHEST PT,  INITIAL TX",41000049,CDM,410,RC,94667,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CHEST PT, SUBSEQ TX",41000050,CDM,410,RC,94668,HCPCS,facility,both,,,,96.68,96.68,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC TRACHEOSTOMY TUBE CHANGE,41000051,CDM,410,RC,31502,HCPCS,facility,both,,,,85.07,85.07,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC CONTINUOUS NEG PRESSURE VENTILATION/PER DAY,41000052,CDM,410,RC,94662,HCPCS,facility,both,,,,464.04,464.04,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC RESPIRATORY FUNCTION THERAPY EA 15 MINS,41000053,CDM,410,RC,,,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CONTINUOUS INHALATION TX, 1ST HOUR",41000200,CDM,410,RC,94644,HCPCS,facility,both,,,,131.48,131.48,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CONTINUOUS INHALATION TX, EA ADD HOUR",41000201,CDM,410,RC,94645,HCPCS,facility,both,,,,108.28,108.28,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC RESPIRATORY MUSCLE THERAPY EA 15 MINS,41000202,CDM,410,RC,,,facility,both,,,,337.4,337.4,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC THERAPEUTIC PROCEDURES - RESP FUNCTION/STRENGTH/ENDURANCE, 2+ PATIENTS",41000204,CDM,410,RC,,,facility,both,,,,337.4,337.4,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC STRAPPING, UNNA BOOT",42000001,CDM,420,RC,29580,HCPCS,facility,both,,,,93.24,93.24,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC STRAPPING, UNNA BOOT",42000001,CDM,420,RC,29580,HCPCS,facility,both,,,,258.41,258.41,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC STRAPPING, UNNA BOOT",42000001,CDM,420,RC,29580,HCPCS,facility,both,,,50,258.41,258.41,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure
HC APPLY SURFACE TENS,42000002,CDM,420,RC,64550,HCPCS,facility,both,,,,72.3,72.3,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY SURFACE TENS,42000002,CDM,420,RC,64550,HCPCS,facility,both,,,,55.9,55.9,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MECHANICAL TRACTION THERAPY,42000003,CDM,420,RC,97012,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC ELECTRICAL STIMULATION EA 15 MINS,42000004,CDM,420,RC,97032,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC ELECTRICAL STIMULATION EA 15 MINS,42000004,CDM,420,RC,97032,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC IONTOPHORESIS THERAPY EA 15 MINS,42000005,CDM,420,RC,97033,HCPCS,facility,both,,,,43.17,43.17,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC IONTOPHORESIS THERAPY EA 15 MINS,42000005,CDM,420,RC,97033,HCPCS,facility,both,,,,59.64,59.64,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC ULTRASOUND THERAPY EA 15 MINS,42000006,CDM,420,RC,97035,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC ULTRASOUND THERAPY EA 15 MINS,42000006,CDM,420,RC,97035,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC THERAPEUTIC EXERCISES EA 15 MINS,42000007,CDM,420,RC,97110,HCPCS,facility,both,,,,57.57,57.57,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC THERAPEUTIC EXERCISES EA 15 MINS,42000007,CDM,420,RC,97110,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC NEUROMUSCULAR REEDUCATION EA 15 MINS,42000008,CDM,420,RC,97112,HCPCS,facility,both,,,,99.39,99.39,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC NEUROMUSCULAR REEDUCATION EA 15 MINS,42000008,CDM,420,RC,97112,HCPCS,facility,both,,,,71.96,71.96,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC GAIT TRAINING THERAPY EA 15 MINS,42000009,CDM,420,RC,97116,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC MASSAGE THERAPY EA 15 MINS,42000010,CDM,420,RC,97124,HCPCS,facility,both,,,,99.39,99.39,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC MASSAGE THERAPY EA 15 MINS,42000010,CDM,420,RC,97124,HCPCS,facility,both,,,,71.96,71.96,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MANUAL THERAPY EA 15 MINS,42000011,CDM,420,RC,97140,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC MANUAL THERAPY EA 15 MINS,42000011,CDM,420,RC,97140,HCPCS,facility,both,,,,57.57,57.57,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS,42000012,CDM,420,RC,97597,HCPCS,facility,both,,,,316.65,316.65,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS,42000012,CDM,420,RC,97597,HCPCS,facility,both,,,,437.31,437.31,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM,42000013,CDM,420,RC,97598,HCPCS,facility,both,,,,159.02,159.02,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM,42000013,CDM,420,RC,97598,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC NEG PRESSURE WOUND TX W/DME, LESS THAN 50 SQ CM",42000014,CDM,420,RC,97605,HCPCS,facility,both,,,,218.66,218.66,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC NEG PRESSURE WOUND TX W/DME, LESS THAN 50 SQ CM",42000014,CDM,420,RC,97605,HCPCS,facility,both,,,,158.32,158.32,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC NEG PRESSURE WOUND TX W/DME, GREATER THAN 50 SQ CM",42000015,CDM,420,RC,97606,HCPCS,facility,both,,,,238.53,238.53,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC NEG PRESSURE WOUND TX W/DME, GREATER THAN 50 SQ CM",42000015,CDM,420,RC,97606,HCPCS,facility,both,,,,172.72,172.72,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS",42000017,CDM,420,RC,97760,HCPCS,facility,both,,,,129.53,129.53,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS",42000017,CDM,420,RC,97760,HCPCS,facility,both,,,,178.9,178.9,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC PROSTHETIC TRAINING, INITIAL ENCOUNTER,  EA 15 MINS",42000018,CDM,420,RC,97761,HCPCS,facility,both,,,,139.15,139.15,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC PROSTHETIC TRAINING, INITIAL ENCOUNTER,  EA 15 MINS",42000018,CDM,420,RC,97761,HCPCS,facility,both,,,,100.75,100.75,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC C/O ORTHOTIC/PROSTH USE EA 15 MINS,42000019,CDM,420,RC,97762,HCPCS,facility,both,,,,63.45,63.45,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC C/O ORTHOTIC/PROSTH USE EA 15 MINS,42000019,CDM,420,RC,97762,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC ELECTRICAL STIMULATION UA (NON-WOUND),42000021,CDM,420,RC,,,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC VASOPNEUMATIC DEVICE THERAPY,42000050,CDM,420,RC,97016,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC VASOPNEUMATIC DEVICE THERAPY,42000050,CDM,420,RC,97016,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC PHYSICAL PERFORMANCE TEST, EA 15 MINS",42000053,CDM,420,RC,97750,HCPCS,facility,both,,,,119.27,119.27,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC PHYSICAL PERFORMANCE TEST, EA 15 MINS",42000053,CDM,420,RC,97750,HCPCS,facility,both,,,,86.36,86.36,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC E STIM WOUND, STAGE 3-4 ULCERS",42000054,CDM,420,RC,,,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC NEG PRESSURE WND TX NON DME < = 50 SQ CM,42000057,CDM,420,RC,97607,HCPCS,facility,both,,,,218.66,218.66,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC NEG PRESSURE WND TX NON DME > 50 SQ CM,42000058,CDM,420,RC,97608,HCPCS,facility,both,,,,238.53,238.53,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY RIGID  TOTAL CONTACT LEG CAST,42000059,CDM,420,RC,29445,HCPCS,facility,both,,,,377.68,377.68,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY RIGID  TOTAL CONTACT LEG CAST,42000059,CDM,420,RC,29445,HCPCS,facility,both,,,,273.46,273.46,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES),42000060,CDM,420,RC,29405,HCPCS,facility,both,,,,215.89,215.89,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES),42000060,CDM,420,RC,29405,HCPCS,facility,both,,,,298.17,298.17,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN",42000061,CDM,420,RC,97763,HCPCS,facility,both,,,,158.32,158.32,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN",42000061,CDM,420,RC,97763,HCPCS,facility,both,,,,218.66,218.66,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC APPLY CAST, HAND AND LOWER FOREARM (GAUNTLET)",42000063,CDM,420,RC,29085,HCPCS,facility,both,,,,377.68,377.68,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC APPLY CAST, HAND AND LOWER FOREARM (GAUNTLET)",42000063,CDM,420,RC,29085,HCPCS,facility,both,,,,273.46,273.46,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC APPLY CAST, FINGER",42000064,CDM,420,RC,29086,HCPCS,facility,both,,,,278.29,278.29,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC APPLY CAST, FINGER",42000064,CDM,420,RC,29086,HCPCS,facility,both,,,,201.5,201.5,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MOBILITY CURRENT STATUS,42090000,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC MOBILITY CURRENT STATUS,42090000,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MOBILITY GOAL STATUS,42090001,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC MOBILITY GOAL STATUS,42090001,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MOBILITY DISCHARGE STATUS,42090002,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC MOBILITY DISCHARGE STATUS,42090002,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC BODY POSITION CURRENT STATUS,42090003,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC BODY POSITION CURRENT STATUS,42090003,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC BODY POSITION GOAL STATUS,42090004,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC BODY POSITION GOAL STATUS,42090004,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC BODY POSITION DISCHARGE STATUS,42090005,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC BODY POSITION DISCHARGE STATUS,42090005,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC CARRY CURRENT STATUS,42090006,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC CARRY CURRENT STATUS,42090006,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC CARRY GOAL STATUS,42090007,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC CARRY GOAL STATUS,42090007,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC CARRY DISCHARGE STATUS,42090008,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC CARRY DISCHARGE STATUS,42090008,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SELF CARE CURRENT STATUS,42090009,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SELF CARE CURRENT STATUS,42090009,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SELF CARE GOAL STATUS,42090010,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SELF CARE GOAL STATUS,42090010,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SELF CARE DISCHARGE STATUS,42090011,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SELF CARE DISCHARGE STATUS,42090011,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OTHER PT/OT CURRENT STATUS,42090012,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC OTHER PT/OT CURRENT STATUS,42090012,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OTHER PT/OT GOAL STATUS,42090013,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OTHER PT/OT GOAL STATUS,42090013,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS,42090014,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS,42090014,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SUBSEQUENT PT/OT CURRENT STATUS,42090015,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SUBSEQUENT PT/OT CURRENT STATUS,42090015,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SUBSEQUENT PT/OT GOAL STATUS,42090016,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SUBSEQUENT PT/OT GOAL STATUS,42090016,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SUBSEQUENT PT/OT DISCHARGE STATUS,42090017,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SUBSEQUENT PT/OT DISCHARGE STATUS,42090017,CDM,420,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC PHYSICAL THERAPY EVALUATION,42400001,CDM,424,RC,97001,HCPCS,facility,both,,,,101.28,101.28,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PHYSICAL THERAPY RE-EVALUATION,42400002,CDM,424,RC,97002,HCPCS,facility,both,,,,75.96,75.96,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PT EVAL LOW COMPLEXITY,42400003,CDM,424,RC,97161,HCPCS,facility,both,,,,159.02,159.02,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PT EVAL MODERATE COMPLEXITY,42400004,CDM,424,RC,97162,HCPCS,facility,both,,,,159.02,159.02,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PT EVAL HIGH COMPLEXITY,42400005,CDM,424,RC,97163,HCPCS,facility,both,,,,159.02,159.02,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PT RE-EVAL EST PLAN CARE,42400006,CDM,424,RC,97164,HCPCS,facility,both,,,,119.27,119.27,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY LONG ARM SPLINT,43000001,CDM,430,RC,29105,HCPCS,facility,both,,,,298.17,298.17,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY LONG ARM SPLINT,43000001,CDM,430,RC,29105,HCPCS,facility,both,,,,215.89,215.89,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC APPLY SHORT ARM SPLINT, STATIC",43000002,CDM,430,RC,29125,HCPCS,facility,both,,,,201.5,201.5,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC APPLY SHORT ARM SPLINT, STATIC",43000002,CDM,430,RC,29125,HCPCS,facility,both,,,,278.29,278.29,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC APPLY SHORT ARM SPLINT, DYNAMIC",43000003,CDM,430,RC,29126,HCPCS,facility,both,,,,230.29,230.29,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC APPLY SHORT ARM SPLINT, DYNAMIC",43000003,CDM,430,RC,29126,HCPCS,facility,both,,,,318.04,318.04,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC APPLY FINGER SPLINT, STATIC",43000004,CDM,430,RC,29130,HCPCS,facility,both,,,,100.75,100.75,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC APPLY FINGER SPLINT, STATIC",43000004,CDM,430,RC,29130,HCPCS,facility,both,,,,139.15,139.15,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC APPLY FINGER SPLINT, DYNAMIC",43000005,CDM,430,RC,29131,HCPCS,facility,both,,,,143.93,143.93,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC APPLY FINGER SPLINT, DYNAMIC",43000005,CDM,430,RC,29131,HCPCS,facility,both,,,,198.78,198.78,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY LONG LEG SPLINT,43000006,CDM,430,RC,29505,HCPCS,facility,both,,,,273.46,273.46,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC APPLY LONG LEG SPLINT,43000006,CDM,430,RC,29505,HCPCS,facility,both,,,,377.68,377.68,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY SHORT LEG SPLINT,43000007,CDM,430,RC,29515,HCPCS,facility,both,,,,187.1,187.1,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC APPLY SHORT LEG SPLINT,43000007,CDM,430,RC,29515,HCPCS,facility,both,,,,258.41,258.41,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PARAFFIN BATH THERAPY,43000010,CDM,430,RC,97018,HCPCS,facility,both,,,,19.88,19.88,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC PARAFFIN BATH THERAPY,43000010,CDM,430,RC,97018,HCPCS,facility,both,,,,14.39,14.39,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC WHIRLPOOL THERAPY,43000011,CDM,430,RC,97022,HCPCS,facility,both,,,,43.17,43.17,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC WHIRLPOOL THERAPY,43000011,CDM,430,RC,97022,HCPCS,facility,both,,,,59.64,59.64,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)",43000012,CDM,430,RC,97150,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)",43000012,CDM,430,RC,97150,HCPCS,facility,both,,,,40.69,40.69,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)",43000012,CDM,430,RC,97150,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (5 OR MORE PTS),43000013,CDM,430,RC,97150,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (5 OR MORE PTS),43000013,CDM,430,RC,97150,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (5 OR MORE PTS),43000013,CDM,430,RC,97150,HCPCS,facility,both,,,,27.14,27.14,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC THERAPEUTIC ACTIVITY DIR EA 15 MINS,43000014,CDM,430,RC,97530,HCPCS,facility,both,,,,139.15,139.15,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC THERAPEUTIC ACTIVITY DIR EA 15 MINS,43000014,CDM,430,RC,97530,HCPCS,facility,both,,,,100.75,100.75,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS,43000015,CDM,430,RC,97532,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS,43000015,CDM,430,RC,97532,HCPCS,facility,both,,,,63.45,63.45,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SENSORY INTEGRATION EA 15 MINS,43000016,CDM,430,RC,97533,HCPCS,facility,both,,,,278.29,278.29,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC SENSORY INTEGRATION EA 15 MINS,43000016,CDM,430,RC,97533,HCPCS,facility,both,,,,201.5,201.5,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ADL/SELF HOME MGMT EA 15 MINS,43000017,CDM,430,RC,97535,HCPCS,facility,both,,,,71.96,71.96,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ADL/SELF HOME MGMT EA 15 MINS,43000017,CDM,430,RC,97535,HCPCS,facility,both,,,,99.39,99.39,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC COMMUNITY/WORK REINTEGRATION EA 15 MINS,43000018,CDM,430,RC,97537,HCPCS,facility,both,,,,71.96,71.96,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC COMMUNITY/WORK REINTEGRATION EA 15 MINS,43000018,CDM,430,RC,97537,HCPCS,facility,both,,,,99.39,99.39,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC WHEELCHAIR MGMT TRAINING EA 15 MINS,43000019,CDM,430,RC,97542,HCPCS,facility,both,,,,71.96,71.96,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC WHEELCHAIR MGMT TRAINING EA 15 MINS,43000019,CDM,430,RC,97542,HCPCS,facility,both,,,,99.39,99.39,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC THERAPEUTIC REHAB GROUP 2 OR MORE,43000020,CDM,430,RC,97150,HCPCS,facility,both,,,,37.75,37.75,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC THERAPEUTIC REHAB GROUP 2 OR MORE,43000020,CDM,430,RC,97150,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC THERAPEUTIC REHAB GROUP 2 OR MORE,43000020,CDM,430,RC,97150,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS,43000027,CDM,430,RC,,,facility,both,,,,77.3,77.3,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS,43000027,CDM,430,RC,,,facility,both,,,,66.3,66.3,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS,43000027,CDM,430,RC,,,facility,both,,,,55.85,55.85,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN,43000028,CDM,430,RC,97129,HCPCS,facility,both,,,,57.57,57.57,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN,43000028,CDM,430,RC,97129,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN,43000028,CDM,430,RC,97129,HCPCS,facility,both,,,,75.51,75.51,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN,43000029,CDM,430,RC,97130,HCPCS,facility,both,,,,75.51,75.51,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN,43000029,CDM,430,RC,97130,HCPCS,facility,both,,,,57.57,57.57,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN,43000029,CDM,430,RC,97130,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC OCCUPATIONAL THERAPY EVALUATION,43400001,CDM,434,RC,97003,HCPCS,facility,both,,,,81.6,81.6,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OCCUPATIONAL THERAPY RE -EVALUATION,43400002,CDM,434,RC,97004,HCPCS,facility,both,,,,61.2,61.2,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OT EVAL LOW COMPLEXITY,43400003,CDM,434,RC,97165,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OT EVAL MOD COMPLEXITY,43400004,CDM,434,RC,97166,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OT EVAL HIGH COMPLEXITY,43400005,CDM,434,RC,97167,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC OT RE-EVAL EST PLAN CARE,43400006,CDM,434,RC,97168,HCPCS,facility,both,,,,86.36,86.36,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC SLV THERAPY, INDIVIDUAL",44000001,CDM,440,RC,92507,HCPCS,facility,both,,,,169.9,169.9,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LARYNGEAL FUNCTION STUDY,44000002,CDM,440,RC,92520,HCPCS,facility,both,,,,339.78,339.78,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC TX SWALLOWING DYSFUNCTION,44000003,CDM,440,RC,92526,HCPCS,facility,both,,,,226.53,226.53,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EVAL TO USE/FIT VOICE PROSTHETIC,44000004,CDM,440,RC,92597,HCPCS,facility,both,,,,151.01,151.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC NON-SPEECH DEVICE TX,44000005,CDM,440,RC,92606,HCPCS,facility,both,,,,169.9,169.9,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC EVAL FOR SPEECH DEVICE RX, 1ST HR",44000006,CDM,440,RC,92607,HCPCS,facility,both,,,,339.78,339.78,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC EVAL FOR SPEECH DEVICE RX, EA ADDL 30 MIN",44000007,CDM,440,RC,92608,HCPCS,facility,both,,,,132.13,132.13,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC THERAPEUTIC SP DEVICE SERVICE,44000008,CDM,440,RC,92609,HCPCS,facility,both,,,,283.15,283.15,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EVALUATE SWALLOWING FUNCTION,44000009,CDM,444,RC,92610,HCPCS,facility,both,,,,226.53,226.53,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC MOTION FLUORO SWALLOW FCN, CINE/VIDEO",44000010,CDM,440,RC,92611,HCPCS,facility,both,,,,434.16,434.16,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC FEES W CINE OR VIDEO,44000011,CDM,440,RC,92612,HCPCS,facility,both,,,,346.39,346.39,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC FEES W CINE OR VIDEO,44000011,CDM,440,RC,92612,HCPCS,facility,both,,,,868.33,868.33,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC FLEX ENDOSCOPIC EVAL, LARYNGEAL SENSORY TEST BY CINE/VIDEO",44000012,CDM,440,RC,92614,HCPCS,facility,both,,,,585.18,585.18,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC FEES & LARYNGEAL SENSORY TEST W CINE/VIDEO,44000013,CDM,440,RC,92616,HCPCS,facility,both,,,,887.21,887.21,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC EVAL AUDITORY FUNCTION, 1ST HR",44000014,CDM,440,RC,92626,HCPCS,facility,both,,,,143.39,143.39,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC EVAL AUDITORY FUNCTION, EA ADDL 15 MIN",44000015,CDM,440,RC,92627,HCPCS,facility,both,,,,35.84,35.84,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC APHASIA ASSESMENT EACH HR,44000018,CDM,440,RC,96105,HCPCS,facility,both,,,,207.65,207.65,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC COGNITIVE ASSESSMENT BY HC PRO PER HR,44000019,CDM,440,RC,96125,HCPCS,facility,both,,,,187.1,187.1,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC COGNITIVE ASSESSMENT BY HC PRO PER HR,44000019,CDM,440,RC,96125,HCPCS,facility,both,,,,245.4,245.4,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC EX FOR NONSPEECH DEVICE RX, 1ST HR",44000030,CDM,440,RC,92605,HCPCS,facility,both,,,,169.9,169.9,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EX FOR NONSPEECH DEV RX EA ADD 30 MIN,44000035,CDM,440,RC,92618,HCPCS,facility,both,,,,56.62,56.62,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC SLV TREATMENT GROUP, 2 OR MORE 2-4",44000050,CDM,440,RC,92508,HCPCS,facility,both,,,,75.51,75.51,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC UNLISTED ENT PROCEDURE/SERVICE,44000051,CDM,444,RC,92700,HCPCS,facility,both,,,,239.36,239.36,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC UNLISTED ENT PROCEDURE/SERVICE,44000051,CDM,444,RC,92700,HCPCS,facility,both,,,,95.59,95.59,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
DEAC 07/01/2024 HC SLV TREATMENT GROUP 5 OR MORE,44000052,CDM,440,RC,92508,HCPCS,facility,both,,,,27.14,27.14,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC SWALLOW CURRENT STATUS,44090000,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SWALLOW CURRENT STATUS,44090000,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC SWALLOW GOAL STATUS,44090001,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SWALLOW GOAL STATUS,44090001,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC SWALLOW DISCHARGE STATUS,44090002,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SWALLOW DISCHARGE STATUS,44090002,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MOTOR SPEECH CURRENT STATUS,44090003,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MOTOR SPEECH CURRENT STATUS,44090003,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MOTOR SPEECH GOAL STATUS,44090004,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MOTOR SPEECH GOAL STATUS,44090004,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MOTOR SPEECH DISCHARGE STATUS,44090005,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MOTOR SPEECH DISCHARGE STATUS,44090005,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC LANGUAGE COMPREHENSION CURRENT STATUS,44090006,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC LANGUAGE COMPREHENSION CURRENT STATUS,44090006,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LANGUAGE COMPREHENSION GOAL STATUS,44090007,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC LANGUAGE COMPREHENSION GOAL STATUS,44090007,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LANGUAGE COMPREHENSION DISCHARGE STATUS,44090008,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LANGUAGE COMPREHENSION DISCHARGE STATUS,44090008,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC LANGUAGE EXPRESSIVE CURRENT STATUS,44090009,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC LANGUAGE EXPRESSIVE CURRENT STATUS,44090009,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LANGUAGE EXPRESSIVE GOAL STATUS,44090010,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LANGUAGE EXPRESSIVE GOAL STATUS,44090010,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC LANGUAGE EXPRESSIVE DISCHARGE STATUS,44090011,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LANGUAGE EXPRESSIVE DISCHARGE STATUS,44090011,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ATTENTION CURRENT STATUS,44090012,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC ATTENTION CURRENT STATUS,44090012,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ATTENTION GOAL STATUS,44090013,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC ATTENTION GOAL STATUS,44090013,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ATTENTION DISCHARGE STATUS,44090014,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ATTENTION DISCHARGE STATUS,44090014,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MEMORY CURRENT STATUS,44090015,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MEMORY CURRENT STATUS,44090015,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MEMORY GOAL STATUS,44090016,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC MEMORY GOAL STATUS,44090016,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MEMORY DISCHARGE STATUS,44090017,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC MEMORY DISCHARGE STATUS,44090017,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC VOICE CURRENT STATUS,44090018,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC VOICE CURRENT STATUS,44090018,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC VOICE GOAL STATUS,44090019,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC VOICE GOAL STATUS,44090019,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC VOICE DISCHARGE STATUS,44090020,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC VOICE DISCHARGE STATUS,44090020,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SPEECH LANGUAGE CURRENT STATUS,44090021,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC SPEECH LANGUAGE CURRENT STATUS,44090021,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SPEECH LANGUAGE GOAL STATUS,44090022,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC SPEECH LANGUAGE GOAL STATUS,44090022,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC SPEECH LANGUAGE DISCHARGE STATUS,44090023,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC SPEECH LANGUAGE DISCHARGE STATUS,44090023,CDM,440,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC EVALUATION OF SPEECH FLUENCY,44400002,CDM,444,RC,92521,HCPCS,facility,both,,,,245.4,245.4,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EVALUATION OF SPEECH SOUND  PRODUCTION,44400003,CDM,444,RC,92522,HCPCS,facility,both,,,,245.4,245.4,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EVALUATION OF SPEECH SOUND  PRODUCTION W/LANGUAGE COMPREHENSION,44400004,CDM,444,RC,92523,HCPCS,facility,both,,,,547.42,547.42,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC BEHAVIORAL & QUALIT ANALYSIS VOICE/RESONANCE,44400005,CDM,444,RC,92524,HCPCS,facility,both,,,,245.4,245.4,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EMERGENCY DEPT VISIT LVL 1,45100001,CDM,451,RC,99281,HCPCS,facility,both,,,,160.66,160.66,,,,,,,,,,,,,Gross Charge Type: BMC 28 EMERGENCY ROOM
HC EMERGENCY DEPT VISIT LVL 2,45200002,CDM,452,RC,99282,HCPCS,facility,both,,,,160.66,160.66,,,,,,,,,,,,,Gross Charge Type: BMC 28 EMERGENCY ROOM
HC EMERGENCY DEPT VISIT LVL 3,45200003,CDM,452,RC,99283,HCPCS,facility,both,,,,321.33,321.33,,,,,,,,,,,,,Gross Charge Type: BMC 28 EMERGENCY ROOM
HC EMERGENCY DEPT VISIT LVL 4,45200004,CDM,452,RC,99284,HCPCS,facility,both,,,,642.66,642.66,,,,,,,,,,,,,Gross Charge Type: BMC 28 EMERGENCY ROOM
HC EMERGENCY DEPT VISIT LVL 5,45200005,CDM,452,RC,99285,HCPCS,facility,both,,,,1124.66,1124.66,,,,,,,,,,,,,Gross Charge Type: BMC 28 EMERGENCY ROOM
HC ER EXTENDED CARE SERVICE,45200025,CDM,452,RC,,,facility,both,,,,160.66,160.66,,,,,,,,,,,,,Gross Charge Type: BMC 28 EMERGENCY ROOM
"DEAC 7/1/2018 HC INCENTIVE SPIROMETRY, INITIAL TX",46000001,CDM,460,RC,94010,HCPCS,facility,both,,,,35.52,35.52,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC INCENTIVE SPIROMETRY, SUBSEQ TX",46000002,CDM,460,RC,94010,HCPCS,facility,both,,,,22.2,22.2,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC SPIROMETRY,46000003,CDM,460,RC,94010,HCPCS,facility,both,,,,562.34,562.34,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC SPIROMETRY,46000003,CDM,460,RC,94010,HCPCS,facility,both,,,,96.68,96.68,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC SPIROMETRY W/BRONCHODILATOR,46000004,CDM,460,RC,94060,HCPCS,facility,both,,,,832.26,832.26,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC BRONCHOSPASM PROVOCATION EVAL,46000005,CDM,460,RC,94070,HCPCS,facility,both,,,,1889.46,1889.46,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC TOTAL VITAL CAPACITY,46000006,CDM,460,RC,94150,HCPCS,facility,both,,,,69.61,69.61,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC MAXIMUM VOLUNTARY VENTILATION,46000007,CDM,460,RC,94200,HCPCS,facility,both,,,,269.92,269.92,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HB RESPIRATORY FLOW VOLUME LOOP - NON-MARYLAND,46000008,CDM,460,RC,94375,HCPCS,facility,both,,,,166.35,166.35,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC CARDIOPULM EXERCISE TEST, INCL MEASURE MIN VENT, CO2, O2  & ECG",46000009,CDM,460,RC,94621,HCPCS,facility,both,,,,2024.41,2024.41,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC OXYGEN UPTAKE REST INDIRECT,46000012,CDM,460,RC,94690,HCPCS,facility,both,,,,232.03,232.03,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC OXYGEN UPTAKE REST INDIRECT,46000012,CDM,460,RC,94690,HCPCS,facility,both,,,,1349.61,1349.61,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC PULMONARY FUNCTION TST PLETHYSMOGRAPHY,46000013,CDM,460,RC,94726,HCPCS,facility,both,,,,427.38,427.38,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC CO/MEMBRANE DIFFUSE CAPACITY,46000014,CDM,460,RC,94729,HCPCS,facility,both,,,,77.35,77.35,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC CO/MEMBRANE DIFFUSE CAPACITY,46000014,CDM,460,RC,94729,HCPCS,facility,both,,,,449.87,449.87,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC PULSE OXIMETRY,46000015,CDM,460,RC,94760,HCPCS,facility,both,,,,179.95,179.95,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC PULSE OXIMETRY,46000015,CDM,460,RC,94760,HCPCS,facility,both,,,,30.94,30.94,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC PULSE OX MULTIPLE, EG EXERCISE",46000016,CDM,460,RC,94761,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC PULSE OX MULTIPLE, EG EXERCISE",46000016,CDM,460,RC,94761,HCPCS,facility,both,,,,674.8,674.8,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, INITIAL DAY",46000017,CDM,460,RC,94770,HCPCS,facility,both,,,,106.56,106.56,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, SUBSEQ DAY",46000018,CDM,460,RC,94770,HCPCS,facility,both,,,,84.36,84.36,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC TENT HUMIDITY THERAPY, INITIAL  DAY",46000020,CDM,460,RC,94799,HCPCS,facility,both,,,,88.8,88.8,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC TENT HUMIDITY THERAPY, SUBSEQ DAY",46000021,CDM,460,RC,94799,HCPCS,facility,both,,,,66.6,66.6,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC ALTERNATIVE GAS ADMINISTRATION, INITIAL DAY",46000022,CDM,460,RC,94799,HCPCS,facility,both,,,,304.14,304.14,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC ALTERNATIVE GAS ADMINISTRATION, SUBSEQ DAY",46000023,CDM,460,RC,94799,HCPCS,facility,both,,,,226.44,226.44,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, INITIAL DAY",46000024,CDM,460,RC,94799,HCPCS,facility,both,,,,77.7,77.7,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, SUBSEQ DAY",46000025,CDM,460,RC,94799,HCPCS,facility,both,,,,66.6,66.6,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC MANUAL VENTILATION PER 15 MIN,46000027,CDM,460,RC,94799,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC NITRIC OXIDE, INITIAL DAY",46000028,CDM,460,RC,94799,HCPCS,facility,both,,,,444,444,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC NITRIC OXIDE, SUBSEQ DAY",46000029,CDM,460,RC,94799,HCPCS,facility,both,,,,377.4,377.4,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC OXYGEN THERAPY, INITIAL DAY",46000030,CDM,460,RC,94799,HCPCS,facility,both,,,,26.64,26.64,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC OXYGEN THERAPY, SUBSEQ DAY",46000031,CDM,460,RC,94799,HCPCS,facility,both,,,,15.54,15.54,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC BEDSIDE PULMONARY MECHANICS,46000032,CDM,460,RC,94799,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC TRACHEOSTOMY TUBE CARE, NON-VENT",46000033,CDM,460,RC,94799,HCPCS,facility,both,,,,77.35,77.35,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC PULMONARY FUNCTION TEST BY GAS,46000052,CDM,460,RC,94727,HCPCS,facility,both,,,,427.38,427.38,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC CONTINUOUS PULSE OX,46000053,CDM,460,RC,94762,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC SURFACTANT ADMIN THRU TUBE,46000054,CDM,460,RC,94610,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC EXHALED NITRIC OXIDE MEASUREMENT,46000055,CDM,460,RC,95012,HCPCS,facility,both,,,,54.67,54.67,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC EXHALED NITRIC OXIDE MEASUREMENT,46000055,CDM,460,RC,95012,HCPCS,facility,both,,,,337.4,337.4,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY < 12 HRS",46000056,CDM,460,RC,94799,HCPCS,facility,both,,,,244.2,244.2,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY > 12 HRS",46000057,CDM,460,RC,94799,HCPCS,facility,both,,,,377.4,377.4,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY < 12 HRS",46000058,CDM,460,RC,94799,HCPCS,facility,both,,,,188.7,188.7,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY > 12 HRS",46000059,CDM,460,RC,94799,HCPCS,facility,both,,,,321.9,321.9,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC HIGH ALTITUDE SIMULATION TEST,46000060,CDM,460,RC,94452,HCPCS,facility,both,,,,1012.21,1012.21,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC HIGH ALTITUDE SIMULATION TEST WITH OXYGEN TITRATION,46000061,CDM,460,RC,94453,HCPCS,facility,both,,,,1012.21,1012.21,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC PULM STRESS TEST(6 MINUTE WALK) INC HR,OXIMET,OXY TITR, WHEN PERF",46000063,CDM,460,RC,94618,HCPCS,facility,both,,,,674.8,674.8,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC EXERCISE TEST BRONCHOSPASM, INCL PRE & POST SPIRO,W/ECG & PULSE OX",46000064,CDM,460,RC,94617,HCPCS,facility,both,,,,1597.04,1597.04,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC CO2 EXPIRED GAS BY IR / PER DAY,46000065,CDM,460,RC,94799,HCPCS,facility,both,,,,154.68,154.68,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC CO2 EXPIRED GAS BY IR / PER DAY,46000065,CDM,460,RC,94799,HCPCS,facility,both,,,,591.89,591.89,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC ALTERNATIVE GAS THERAPY, PER DAY",46000066,CDM,460,RC,94799,HCPCS,facility,both,,,,464.04,464.04,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CONTINOUS AEROSOL MIST W/WO OXYGEN, PER DAY",46000067,CDM,460,RC,94799,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC HEAT HF NASAL CANNULA, PER DAY",46000068,CDM,460,RC,94799,HCPCS,facility,both,,,,464.04,464.04,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC INHALED NITRIC OXIDE THERAPY, PER DAY",46000069,CDM,460,RC,94799,HCPCS,facility,both,,,,966.76,966.76,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC OXYGEN THERAPY, PER DAY",46000070,CDM,460,RC,94799,HCPCS,facility,both,,,,77.35,77.35,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC GENERAL PROCEDURAL ASSIST,46000071,CDM,460,RC,94799,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC BREATHING RESPONSE TO CO2,46000072,CDM,460,RC,94799,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CONT AEROSOL TX W/O BRONCHODILATION, PER DAY",46000073,CDM,460,RC,94799,HCPCS,facility,both,,,,966.76,966.76,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC MINI BRONCHOALVEOLAR LAVAGE TEST,46000074,CDM,460,RC,94799,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC RAPID RESPONSE TEAM,46000075,CDM,460,RC,94799,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC TRANSCUTANEOUS BEDSIDE MONITORING, PER DAY",46000076,CDM,460,RC,94799,HCPCS,facility,both,,,,154.68,154.68,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC BEDSIDE SLEEP APNEA SCREENING,46000077,CDM,460,RC,94799,HCPCS,facility,both,,,,116.01,116.01,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC DRUG ADMINISTRATION (NITRIC OXIDE) & HEMODYNMIC MEASURES,46000078,CDM,460,RC,93463,HCPCS,facility,both,,,,177.88,177.88,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC NON-EMERGENT NIV PT COMPLIANCE STUDY,46000079,CDM,460,RC,94799,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC BASIC VESTIBULAR EVALUATION,47000005,CDM,470,RC,92540,HCPCS,facility,both,,,,203.13,203.13,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC USE VERTICAL ELECTRODES,47000012,CDM,471,RC,92547,HCPCS,facility,both,,,,35.84,35.84,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC AUDITORY EVOKED POTENTIALS; SCRN AUDIT POTENT W/STIMULI, AUTO ANALYS",47000017,CDM,471,RC,92650,HCPCS,facility,both,,,,71.69,71.69,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC AUDITORY EVOKED POTENTIALS; HEARING STATUS DETER, BBAND STIMULI, I&R",47000018,CDM,471,RC,92651,HCPCS,facility,both,,,,179.23,179.23,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC AUDITORY EVOKED POTENTIALS; THRESHOLD ESTIM AT MULTI FREQ, I & R",47000019,CDM,471,RC,92652,HCPCS,facility,both,,,,215.08,215.08,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC AUDITORY EVOKED POTENTIALS; NEURODIAGNOSTIC, W/INTRP & RPT",47000020,CDM,471,RC,92653,HCPCS,facility,both,,,,167.29,167.29,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC PURE TONE AUDIOMETRY, AIR ONLY",47100002,CDM,471,RC,92552,HCPCS,facility,both,,,,131.43,131.43,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC PURE TONE AUDIOMETRY, AIR & BONE",47100003,CDM,471,RC,92553,HCPCS,facility,both,,,,155.34,155.34,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC SPEECH AUDIOMETRY THESHOLD W/SR,47100004,CDM,471,RC,92556,HCPCS,facility,both,,,,155.34,155.34,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC SPEECH AUDIOMETRY W/SR, COMPREHENSIVE",47100005,CDM,471,RC,92557,HCPCS,facility,both,,,,310.67,310.67,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC TYMPANOMETRY (IMP TESTING),47100006,CDM,471,RC,92567,HCPCS,facility,both,,,,35.84,35.84,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC ACOUSTIC REFLEX TESTING,47100007,CDM,471,RC,92568,HCPCS,facility,both,,,,23.9,23.9,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC VISUAL REINFORCE AUDIOMETRY,47100008,CDM,471,RC,92579,HCPCS,facility,both,,,,131.43,131.43,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC CONDITIONING PLAY AUDIOMETRY,47100009,CDM,471,RC,92582,HCPCS,facility,both,,,,286.77,286.77,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC DEAC 01/01/2021  AUDITORY EP - COMPREHENSIVE,47100010,CDM,471,RC,92585,HCPCS,facility,both,,,,241.49,241.49,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC DEAC 01/01/2021  AUDITORY EP - COMPREHENSIVE,47100010,CDM,471,RC,92585,HCPCS,facility,both,,,,273.33,273.33,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC EVOKED AUDITORY TEST LIMITED,47100012,CDM,471,RC,92587,HCPCS,facility,both,,,,56.62,56.62,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC EVOKED AUDITORY TEST LIMITED,47100012,CDM,471,RC,92587,HCPCS,facility,both,,,,35.84,35.84,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC ELECTRO HEARING AID TEST, MONAURAL",47100013,CDM,471,RC,92594,HCPCS,facility,both,,,,157.49,157.49,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
"HC ELECTRO HEARING AID TEST, BINAURAL",47100014,CDM,471,RC,92595,HCPCS,facility,both,,,,188.97,188.97,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC SPEECH AUDIOMETRY THRESHOLD,47100015,CDM,471,RC,92555,HCPCS,facility,both,,,,95.59,95.59,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC ACOUSTIC IMMITTANCE TESTING,47100016,CDM,471,RC,92570,HCPCS,facility,both,,,,83.64,83.64,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC SELECT PICTURE AUDIOMETRY,47100017,CDM,471,RC,92583,HCPCS,facility,both,,,,191.18,191.18,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC ELECTROCOCHLEOGRAPHY,47100018,CDM,471,RC,92584,HCPCS,facility,both,,,,274.82,274.82,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC EVOKED AUDITORY TEST COMPLETE,47100019,CDM,471,RC,92588,HCPCS,facility,both,,,,71.69,71.69,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC NASAL FUNCTION STUDIES,47100021,CDM,471,RC,92512,HCPCS,facility,both,,,,141.72,141.72,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
DEAC 9/2016 HC BINOCULAR MICROSCOPY,47100022,CDM,471,RC,92504,HCPCS,facility,both,,,,134.53,134.53,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC NASOPHARYNGOSCOPY,47100150,CDM,471,RC,92511,HCPCS,facility,both,,,,346.51,346.51,,,,,,,,,,,,,Gross Charge Type: BMC 59 AUDIOLOGY
HC IRC CARDIOLOGY PRICE PER MINUTE,48000001,CDM,480,RC,,,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC MYOCRD STRAIN IMG USING SPECKLE TRCK ASSMT OF MYOCRD MECHAN,48000003,CDM,483,RC,93356,HCPCS,facility,both,,,,160.72,160.72,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TILT TABLE EVALUATION - STANDARD,48100050,CDM,481,RC,93660,HCPCS,facility,both,,,,964.34,964.34,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC CARDIOVERSION ELECTRICAL CONVERSION, EXTERNAL",48100058,CDM,481,RC,92960,HCPCS,facility,both,,,,723.26,723.26,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC CARDIOVERSION WITH TEE,48100059,CDM,481,RC,92960,HCPCS,facility,both,,,,80.37,80.37,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TILT TABLE EVALUATION - COMPLEX,48100060,CDM,481,RC,93660,HCPCS,facility,both,,,,1446.51,1446.51,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC 12 CVSLR STRESS TEST; TRACING,48200001,CDM,482,RC,93017,HCPCS,facility,both,,,,482.17,482.17,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC PM DEVICE PROGR EVAL, SNGL",48300001,CDM,483,RC,93279,HCPCS,facility,both,,,,241.09,241.09,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC PM DEVICE PROGR EVAL, DUAL",48300002,CDM,483,RC,93280,HCPCS,facility,both,,,,241.09,241.09,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC PM DEVICE PROGR EVAL, MULTI",48300003,CDM,483,RC,93281,HCPCS,facility,both,,,,241.09,241.09,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC ICD DEVICE PROG EVAL, 1 SINGLE",48300004,CDM,483,RC,93282,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC ICD DEVICE PROGR EVAL, DUAL",48300005,CDM,483,RC,93283,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC ICD DEVICE PROGR EVAL, MULT",48300006,CDM,483,RC,93284,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC PM DEVICE EVAL IN PERSON,48300010,CDM,483,RC,93288,HCPCS,facility,both,,,,241.09,241.09,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC ICD DEVICE INTERROGATE,48300011,CDM,483,RC,93289,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC ILR DEVICE INTERROGATE,48300012,CDM,483,RC,93291,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TTE CONG ABN; COMPLETE,48300014,CDM,483,RC,93303,HCPCS,facility,both,,,,723.26,723.26,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TTE CONG ABN; LIMITED/F-UP,48300015,CDM,483,RC,93304,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TTE W/DOPPLER COMPLETE,48300016,CDM,483,RC,93306,HCPCS,facility,both,,,,964.34,964.34,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TTE F-UP OR LMTD,48300018,CDM,483,RC,93308,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC ECHO TRANSESOPHAGEAL COMPLETE,48300019,CDM,483,RC,93312,HCPCS,facility,both,,,,964.34,964.34,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC DOPPLER ECHO; COMPLETE,48300022,CDM,483,RC,93320,HCPCS,facility,both,,,,160.72,160.72,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC DOPPLER ECHO; LIMITED/ F-UP,48300023,CDM,483,RC,93321,HCPCS,facility,both,,,,128.58,128.58,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC DOPPLER COLOR FLOW,48300024,CDM,483,RC,93325,HCPCS,facility,both,,,,80.37,80.37,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC STRESS TTE ONLY,48300025,CDM,483,RC,93350,HCPCS,facility,both,,,,964.34,964.34,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TTE W OR W/O FOL W/CONTRAST,48300026,CDM,483,RC,,,facility,both,,,,739.33,739.33,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC 2D TTE W OR W/O FOL W/CONTRAST,48300027,CDM,483,RC,,,facility,both,,,,739.33,739.33,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC 2D TTE W OR W/O FOL W/CON FU,48300028,CDM,483,RC,,,facility,both,,,,337.52,337.52,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC 2D TEE W OR W/O FOL W/CON IN,48300029,CDM,483,RC,,,facility,both,,,,980.42,980.42,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC TTE W OR W/O FOL W/CON STRES,48300030,CDM,483,RC,,,facility,both,,,,980.42,980.42,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC STRESS TTE COMPLETE,48300031,CDM,483,RC,93351,HCPCS,facility,both,,,,964.34,964.34,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC TTE W OR WO FOLLOWED BY W/CONTRAST, DOPPLER",48300035,CDM,483,RC,,,facility,both,,,,980.42,980.42,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC NEEDLE EMG ANAL/URETHRAL SPHINCTER,49000003,CDM,920,RC,51785,HCPCS,facility,both,,,,681.31,681.31,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC HOSPITAL OUTPATIENT CLINIC VISIT,51000001,CDM,510,RC,99211,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HOSPITAL OUTPATIENT CLINIC VISIT,51000001,CDM,510,RC,99211,HCPCS,facility,both,,,,46.65,46.65,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC HOSPITAL OUTPATIENT CLINIC VISIT,51000001,CDM,510,RC,99211,HCPCS,facility,both,,,,70.47,70.47,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT NEW LVL 2,51000002,CDM,510,RC,99202,HCPCS,facility,both,,,,105.74,105.74,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT NEW LVL 2,51000002,CDM,510,RC,99202,HCPCS,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT NEW LVL 2,51000002,CDM,510,RC,99202,HCPCS,facility,both,,,,76.32,76.32,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT NEW LVL 3,51000003,CDM,510,RC,99203,HCPCS,facility,both,,,,119.17,119.17,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT NEW LVL 3,51000003,CDM,510,RC,99203,HCPCS,facility,both,,,,140.96,140.96,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT NEW LVL 3,51000003,CDM,510,RC,99203,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT NEW LVL 4,51000004,CDM,510,RC,99204,HCPCS,facility,both,,,,176.19,176.19,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT NEW LVL 4,51000004,CDM,510,RC,99204,HCPCS,facility,both,,,,178.2,178.2,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT NEW LVL 4,51000004,CDM,510,RC,99204,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT NEW LVL 5,51000005,CDM,510,RC,99205,HCPCS,facility,both,,,,235.41,235.41,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT NEW LVL 5,51000005,CDM,510,RC,99205,HCPCS,facility,both,,,,211.43,211.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT NEW LVL 5,51000005,CDM,510,RC,99205,HCPCS,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,70.47,70.47,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,24.87,24.87,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,55.5,55.5,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,60.09,60.09,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,105.74,105.74,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,97.02,97.02,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,140.96,140.96,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT EST LVL 4,51000009,CDM,510,RC,99214,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OFFICE/OUTPATIENT VISIT EST LVL 4,51000009,CDM,510,RC,99214,HCPCS,facility,both,,,,136.43,136.43,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT EST LVL 4,51000009,CDM,510,RC,99214,HCPCS,facility,both,,,,176.19,176.19,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT EST LVL 5,51000010,CDM,510,RC,99215,HCPCS,facility,both,,,,211.43,211.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC OFFICE/OUTPATIENT VISIT EST LVL 5,51000010,CDM,510,RC,99215,HCPCS,facility,both,,,,191.23,191.23,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC OFFICE/OUTPATIENT VISIT EST LVL 5,51000010,CDM,510,RC,99215,HCPCS,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC SPECIAL PROGRAMS EDUCATION AND TRAINING,51000024,CDM,510,RC,99211,HCPCS,facility,both,,,,22.25,22.25,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC AMBULANCE-BASE CHARGE,54200001,CDM,542,RC,,,facility,both,,,,1121.41,1121.41,,,,,,,,,,,,,Gross Charge Type: BMC 62 AMBULANCE
HC AMBULANCE PER MILE,54200002,CDM,542,RC,,,facility,both,,,,14.96,14.96,,,,,,,,,,,,,Gross Charge Type: BMC 62 AMBULANCE
HC AMBULANCE ADS - BASE CHARGE,54200003,CDM,542,RC,,,facility,both,,,,2242.8,2242.8,,,,,,,,,,,,,Gross Charge Type: BMC 62 AMBULANCE
HC AMBULANCE PER MILE,54200004,CDM,542,RC,,,facility,both,,,,29.9,29.9,,,,,,,,,,,,,Gross Charge Type: BMC 62 AMBULANCE
HC MRI OF TEMPOROMANDIBULAR JOINT(S),61000001,CDM,610,RC,70336,HCPCS,facility,both,,,,1616.54,1616.54,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ORBIT/FACE/NECK W/O CONTRAST,61000002,CDM,610,RC,70540,HCPCS,facility,both,,,,1524.16,1524.16,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ORBIT/FACE/NECK W/CONTRAST,61000003,CDM,610,RC,70542,HCPCS,facility,both,,,,1662.72,1662.72,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ORBIT/FACE/NECK W/O & W/CONTRAST,61000004,CDM,610,RC,70543,HCPCS,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI CHEST W/O CONTRAST,61000005,CDM,610,RC,71550,HCPCS,facility,both,,,,2216.96,2216.96,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI CHEST W CONTRAST,61000006,CDM,610,RC,71551,HCPCS,facility,both,,,,2424.81,2424.81,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI CHEST W & W/O CONTRAST,61000007,CDM,610,RC,71552,HCPCS,facility,both,,,,3025.23,3025.23,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI PELVIS W/O CONTRAST,61000008,CDM,610,RC,72195,HCPCS,facility,both,,,,1962.94,1962.94,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI PELVIS W CONTRAST,61000009,CDM,610,RC,72196,HCPCS,facility,both,,,,2101.5,2101.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI PELVIS W & W/O CONTRAST,61000010,CDM,610,RC,72197,HCPCS,facility,both,,,,2540.27,2540.27,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI UPPER EXT NOT JOINT W/O CONTRAST,61000011,CDM,610,RC,73218,HCPCS,facility,both,,,,1939.85,1939.85,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI UPPER EXT NOT JOINT W/ CONTRAST,61000012,CDM,610,RC,73219,HCPCS,facility,both,,,,2078.4,2078.4,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST,61000013,CDM,610,RC,73220,HCPCS,facility,both,,,,2540.27,2540.27,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI UPPER EXT ANY JOINT W/O CONTRAST,61000014,CDM,610,RC,73221,HCPCS,facility,both,,,,1085.39,1085.39,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI UPPER EXT ANY JOINT W CONTRAST,61000015,CDM,610,RC,73222,HCPCS,facility,both,,,,1916.75,1916.75,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST,61000016,CDM,610,RC,73223,HCPCS,facility,both,,,,2355.52,2355.52,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI LOWER EXT NOT JOINT W/O CONTRAST,61000017,CDM,610,RC,73718,HCPCS,facility,both,,,,1916.75,1916.75,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI LOWER EXT NOT JOINT W CONTRAST,61000018,CDM,610,RC,73719,HCPCS,facility,both,,,,2101.5,2101.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ANY JOINT LOWER EXT W/O CONTRAST,61000019,CDM,610,RC,73721,HCPCS,facility,both,,,,1085.39,1085.39,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ANY JOINT LOWER EXT W/CONTRAST,61000020,CDM,610,RC,73722,HCPCS,facility,both,,,,1939.85,1939.85,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ANY JOINT LOWER EXT W/O & W CON,61000021,CDM,610,RC,73723,HCPCS,facility,both,,,,2355.52,2355.52,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ABDOMEN W/O CONTRAST,61000022,CDM,610,RC,74181,HCPCS,facility,both,,,,1685.81,1685.81,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ABDOMEN W CONTRAST,61000023,CDM,610,RC,74182,HCPCS,facility,both,,,,2378.62,2378.62,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI ABDOMEN W & W/O CONTRAST,61000024,CDM,610,RC,74183,HCPCS,facility,both,,,,2563.36,2563.36,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC CARDIAC MRI FOR MORPH & FUNC W/O CONTRAST,61000025,CDM,610,RC,75557,HCPCS,facility,both,,,,1316.32,1316.32,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC CARDIAC MRI FOR MORPH & FUNC W/W/O CON,61000026,CDM,610,RC,75561,HCPCS,facility,both,,,,1916.75,1916.75,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC CARDIAC MRI W & W/O CONTRAST W/STRESS,61000027,CDM,610,RC,75563,HCPCS,facility,both,,,,2332.43,2332.43,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC UNLISTED MAGNETIC RESONANCE PROCEDURE,61000028,CDM,610,RC,76498,HCPCS,facility,both,,,,1032.5,1032.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI NEEDLE GUIDANCE,61000029,CDM,610,RC,77021,HCPCS,facility,both,,,,124.33,124.33,,,,,,,,,,,,,Gross Charge Type: BMC 78 IVC
HC MRI BREAST UNILATERAL W & OR W/O CONTRAST,61000030,CDM,610,RC,77058,HCPCS,facility,both,,,,2146.56,2146.56,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BREAST BILATERAL W & OR W/O CONTRAST,61000031,CDM,610,RC,77059,HCPCS,facility,both,,,,2129.92,2129.92,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI LEXTREM W&WO CONTR,61000040,CDM,610,RC,73720,HCPCS,facility,both,,,,2563.36,2563.36,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MAGNETIC RESONANCE SPECTROSCOPY,61000045,CDM,610,RC,76390,HCPCS,facility,both,,,,2447.9,2447.9,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC CARDIAC MRI FOR VELOCITY FLOW MAPPING (ADD-ON),61000046,CDM,610,RC,75565,HCPCS,facility,both,,,,277.12,277.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BREAST UNIL W/O CONTRAST,61000048,CDM,610,RC,77046,HCPCS,facility,both,,,,2146.56,2146.56,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BREAST BILAT W/O CONTRAST,61000050,CDM,610,RC,77047,HCPCS,facility,both,,,,2129.92,2129.92,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC CARDIAC MRI FOR MORPHOLOGY & FUNCTION, W/O CONTRAST; W/STRESS IMAGE",61000053,CDM,610,RC,75559,HCPCS,facility,both,,,,1916.75,1916.75,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MAGNETIC RESONANCE ELASTOGRAPHY,61000056,CDM,610,RC,76391,HCPCS,facility,both,,,,2979.05,2979.05,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BRAIN W/O CONTRAST,61100001,CDM,611,RC,70551,HCPCS,facility,both,,,,1016.11,1016.11,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BRAIN W CONTRAST,61100002,CDM,611,RC,70552,HCPCS,facility,both,,,,1501.07,1501.07,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BRAIN W & W/O CONTRAST,61100003,CDM,611,RC,70553,HCPCS,facility,both,,,,1708.91,1708.91,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI BRAIN,  FUNCTIONAL, BY TECH",61100004,CDM,611,RC,70554,HCPCS,facility,both,,,,3464.01,3464.01,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI BRAIN,  FUNCTIONAL, BY PHYSICIAN/PSYCH",61100005,CDM,611,RC,70555,HCPCS,facility,both,,,,3464.01,3464.01,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE CERVICAL, W/O CONTRAST",61200001,CDM,612,RC,72141,HCPCS,facility,both,,,,969.92,969.92,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE CERVICAL, W CONTRAST",61200002,CDM,612,RC,72142,HCPCS,facility,both,,,,1524.16,1524.16,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE THORACIC, W/O CONTRAST",61200003,CDM,612,RC,72146,HCPCS,facility,both,,,,969.92,969.92,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE THORACIC, W CONTRAST",61200004,CDM,612,RC,72147,HCPCS,facility,both,,,,1524.16,1524.16,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE LUMBAR, W/O CONTRAST",61200005,CDM,612,RC,72148,HCPCS,facility,both,,,,969.92,969.92,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE LUMBAR, W CONTRAST",61200006,CDM,612,RC,72149,HCPCS,facility,both,,,,1501.07,1501.07,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE CERVICAL, W & W/O CONTRAST",61200007,CDM,612,RC,72156,HCPCS,facility,both,,,,1708.91,1708.91,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE THORACIC, W & W/O CONTRAST",61200008,CDM,612,RC,72157,HCPCS,facility,both,,,,1732,1732,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRI SPINE LUMBAR, W & W/O CONTRAST",61200009,CDM,612,RC,72158,HCPCS,facility,both,,,,1708.91,1708.91,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BREAST UNILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61400001,CDM,614,RC,,,facility,both,,,,2979.05,2979.05,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BREAST BILAT W CONTR,61400002,CDM,614,RC,,,facility,both,,,,2955.95,2955.95,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRI BREAST BILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61400004,CDM,614,RC,,,facility,both,,,,2955.95,2955.95,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA HEAD W/O CONTRAST,61500001,CDM,615,RC,70544,HCPCS,facility,both,,,,2147.68,2147.68,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA HEAD W CONTRAST,61500002,CDM,615,RC,70545,HCPCS,facility,both,,,,2124.59,2124.59,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA HEAD W & W/O CONTRAST,61500003,CDM,615,RC,70546,HCPCS,facility,both,,,,3302.35,3302.35,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA NECK W/O CONTRAST,61500004,CDM,615,RC,70547,HCPCS,facility,both,,,,2170.77,2170.77,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA NECK W CONTRAST,61500005,CDM,615,RC,70548,HCPCS,facility,both,,,,2286.25,2286.25,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA NECK W & W/O CONTRAST,61500006,CDM,615,RC,70549,HCPCS,facility,both,,,,3325.45,3325.45,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA LOWER EXT W/W/O CONTRAST,61600001,CDM,616,RC,73725,HCPCS,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA LEXTREM W CONT,61600005,CDM,616,RC,,,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA LOWER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61600006,CDM,616,RC,,,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRA WO CONTRAST, LOWER EXT",61600007,CDM,616,RC,,,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA CHEST W OR W/O CONTRAST,61800001,CDM,618,RC,71555,HCPCS,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA SPINE W OR W/O CONTRAST,61800002,CDM,618,RC,72159,HCPCS,facility,both,,,,2124.59,2124.59,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA UPPER EXT W OR W/O CONTRAST,61800003,CDM,618,RC,73225,HCPCS,facility,both,,,,2101.5,2101.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA ABDOMEN W OR W/O CONTRAST,61800004,CDM,618,RC,74185,HCPCS,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA PELVIS,61800010,CDM,618,RC,72198,HCPCS,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA ABD W CONTRAST,61800011,CDM,618,RC,,,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA ABDOMEN WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800012,CDM,618,RC,,,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA CHEST W CONTRAST,61800013,CDM,618,RC,,,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA PELVIS WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800014,CDM,618,RC,,,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
"HC MRA W CONTRAST, PELVIS",61800015,CDM,618,RC,,,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA ABD WO CONTRAST,61800016,CDM,618,RC,,,facility,both,,,,2032.22,2032.22,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA CHEST WO CONRAST,61800025,CDM,618,RC,,,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA CHEST WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800026,CDM,618,RC,,,facility,both,,,,2009.12,2009.12,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA W/CONTRAST UPPER EXTREMITY,61800027,CDM,618,RC,,,facility,both,,,,2101.5,2101.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA W/O CONTRAST UPPER EXTREMITY,61800028,CDM,618,RC,,,facility,both,,,,2101.5,2101.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA UPPER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800029,CDM,618,RC,,,facility,both,,,,2101.5,2101.5,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA W/CONTRAST SPINAL CANAL,61800030,CDM,618,RC,,,facility,both,,,,2124.59,2124.59,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC MRA SPINAL CANAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800032,CDM,618,RC,,,facility,both,,,,2124.59,2124.59,,,,,,,,,,,,,Gross Charge Type: BMC 61 MRI
HC APPLY LONG ARM CAST,70000001,CDM,700,RC,29065,HCPCS,facility,both,,,,397.55,397.55,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY LONG ARM CAST,70000001,CDM,700,RC,29065,HCPCS,facility,both,,,,287.86,287.86,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC APPLY SHORT ARM CAST,70000002,CDM,700,RC,29075,HCPCS,facility,both,,,,259.07,259.07,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC APPLY SHORT ARM CAST,70000002,CDM,700,RC,29075,HCPCS,facility,both,,,,357.8,357.8,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC OUTPATIENT MATERNAL OBSERVATION PER HR,72000001,CDM,720,RC,,,facility,both,,,,282.6,282.6,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC OUTPATIENT MATERNAL INTENSIVE CARE PER HR,72000002,CDM,720,RC,,,facility,both,,,,565.2,565.2,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC ASSESSMENT/TRIAGE SERVICE FEE,72000003,CDM,720,RC,,,facility,both,,,,282.6,282.6,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC FETAL DEMISE/GENETIC TERMINATION 2/3 TRIM,72000004,CDM,720,RC,,,facility,both,,,,8477.93,8477.93,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC FETAL DEMISE/GENETIC TERMINATION W/EPIDURAL,72000005,CDM,720,RC,,,facility,both,,,,10173.51,10173.51,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC DELIVERY OUTSIDE HOSPITAL,72000006,CDM,720,RC,,,facility,both,,,,3391.17,3391.17,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC VAGINAL DELVERY (NO ANES, UNCOMPLICATED)",72000007,CDM,722,RC,,,facility,both,,,,6782.34,6782.34,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC VAGINAL DELVERY W/VACUUM FORCEPS ASST,72000008,CDM,722,RC,,,facility,both,,,,7347.54,7347.54,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC VAGINAL DELIVERY W/EPI ANESTHESIA,72000009,CDM,722,RC,,,facility,both,,,,8477.93,8477.93,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC VAGINAL DELIVERY W/EPI & FORCEPS VACUUM,72000010,CDM,722,RC,,,facility,both,,,,9043.12,9043.12,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC VAGINAL DELIVERY PRIOR C-SECTION (VBAC),72000011,CDM,722,RC,,,facility,both,,,,9043.12,9043.12,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC CESAREAN SECTION, NON-EMERGENT",72000012,CDM,722,RC,,,facility,both,,,,5086.75,5086.75,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC CESAREAN SECTION, NON-EMERGENT W/MINOR SURG",72000013,CDM,722,RC,,,facility,both,,,,5651.95,5651.95,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC CESAREAN SECTION, NON-EMERGENT W/MAJOR SURG",72000014,CDM,722,RC,,,facility,both,,,,8760.53,8760.53,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC CESAREAN SECTION, EMERGENCY",72000015,CDM,720,RC,,,facility,both,,,,10456.11,10456.11,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC CESAREAN SECTION, EMERGENT W/MINOR SURG",72000016,CDM,722,RC,,,facility,both,,,,11021.3,11021.3,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC CESAREAN SECTION, EMERGENT W/MAJOR SURG",72000017,CDM,722,RC,,,facility,both,,,,17238.45,17238.45,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC ABD AMNIOINFUSION W/US,72000018,CDM,720,RC,,,facility,both,,,,1695.59,1695.59,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC DELIVERY DOUBLE SET-UP/FAILED FORCEPS/VACUUM,72000019,CDM,720,RC,,,facility,both,,,,565.2,565.2,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC INDUCTION/AUGMENTATION W/DELIVERY,72000020,CDM,722,RC,,,facility,both,,,,1130.39,1130.39,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC INTRAUTERINE PRESSURE CATH MONITOR (IUPC),72000021,CDM,720,RC,59050,HCPCS,facility,both,,,,565.2,565.2,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC MULTIPLE BIRTH: TWINS,72000022,CDM,722,RC,,,facility,both,,,,1695.59,1695.59,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC MULTIPLE BIRTH: TRIPLETS,72000023,CDM,722,RC,,,facility,both,,,,2543.38,2543.38,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC MULTIPLE BIRTH: QUADS,72000024,CDM,722,RC,,,facility,both,,,,3391.17,3391.17,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC NEONATAL RESUSCITATION,72000025,CDM,720,RC,,,facility,both,,,,1130.39,1130.39,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC SURGERY, ADDL MINOR, NON-EMERGENT",72000026,CDM,720,RC,,,facility,both,,,,2260.78,2260.78,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC SURGERY, ADDL MAJOR, NON-EMERGENT",72000027,CDM,720,RC,,,facility,both,,,,5369.35,5369.35,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC SURGERY, ADDL MINOR, EMERGENT",72000028,CDM,720,RC,,,facility,both,,,,4521.56,4521.56,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC SURGERY, ADDL MAJOR, EMERGENT",72000029,CDM,720,RC,,,facility,both,,,,10738.7,10738.7,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC AMNIOCENTESIS, DIAGNOSTIC",72000032,CDM,720,RC,59000,HCPCS,facility,both,,,,847.79,847.79,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC CERVICAL CERCLAGE,72000033,CDM,720,RC,,,facility,both,,,,2825.98,2825.98,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC DILATION & CURETTAGE (D & C),72000034,CDM,720,RC,,,facility,both,,,,2543.38,2543.38,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC DILATION & EVACUATION (D & E),72000035,CDM,720,RC,,,facility,both,,,,2543.38,2543.38,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC EXTERNAL CEPHALIC VERSIONS,72000036,CDM,720,RC,59412,HCPCS,facility,both,,,,2825.98,2825.98,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC NON-STRESS TEST,72000037,CDM,720,RC,59025,HCPCS,facility,both,,,59,847.79,847.79,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service
HC NON-STRESS TEST,72000037,CDM,720,RC,59025,HCPCS,facility,both,,,,1412.99,1412.99,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC OXYTOCIN STRESS TEST,72000038,CDM,720,RC,59020,HCPCS,facility,both,,,,1412.99,1412.99,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC MINOR OR PROC, EMERG OR NON-EMERG WO DEL",72000060,CDM,720,RC,,,facility,both,,,,2260.78,2260.78,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
"HC MAJOR OR PROC, EMERG OR NON-EMERG WO DEL",72000061,CDM,720,RC,,,facility,both,,,,10738.7,10738.7,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC ATTENDANCE AT DELIVERY  INIT STABILIZATION OF NB,72000065,CDM,722,RC,99464,HCPCS,facility,both,,,,232.03,232.03,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC CIRCUMCISION (INCL NURSERY),72300001,CDM,723,RC,,,facility,both,,,,847.79,847.79,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC 12 LEAD EKG; TRACING ONLY,73000001,CDM,730,RC,93005,HCPCS,facility,both,,,,192.87,192.87,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC RHYTHM ECG 1-3 LEADS TRACING,73000003,CDM,730,RC,93041,HCPCS,facility,both,,,,80.37,80.37,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC ECG UP TO 48 HRS SCANNING ANALYSIS REPORT,73100001,CDM,731,RC,93226,HCPCS,facility,both,,,,803.62,803.62,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC REMOTE PT 30 DAY ECG REV/REPORT,73100002,CDM,731,RC,93270,HCPCS,facility,both,,,,160.72,160.72,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC EXTERNAL ECG REC > 48 HR UP TO 7 DAYS RECORD; INCL CONNECT & INITIAL REC,73100010,CDM,731,RC,93242,HCPCS,facility,both,,,,160.72,160.72,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC EXTERNAL ECG REC > 7 DAYS  UP TO 15 DAYS  RECORDING; INCL CONNECT & INITIAL REC,73100011,CDM,731,RC,93246,HCPCS,facility,both,,,,160.72,160.72,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC ECG UP TO 48 HRS RECORDING,73100100,CDM,731,RC,93225,HCPCS,facility,both,,,,160.72,160.72,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC MSLT- SLEEP LATENCY,74000001,CDM,740,RC,95805,HCPCS,facility,both,,,,1403.49,1403.49,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC POLYSOMNOGRAPHY W/4> PARAM,74000002,CDM,740,RC,95810,HCPCS,facility,both,,,,1907.65,1907.65,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC CPAP- SLEEP STAGING, >4 PAR",74000003,CDM,740,RC,95811,HCPCS,facility,both,,,,2016.66,2016.66,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EXTENDED EEG 41-60 MIN,74000004,CDM,740,RC,95812,HCPCS,facility,both,,,,1021.95,1021.95,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG EXTENDED MONITORING; 61-119 MIN,74000005,CDM,740,RC,95813,HCPCS,facility,both,,,,1226.35,1226.35,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG AWAKE & DROWSY,74000006,CDM,740,RC,95816,HCPCS,facility,both,,,,1158.22,1158.22,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG AWAKE & ASLEEP,74000007,CDM,740,RC,95819,HCPCS,facility,both,,,,1376.24,1376.24,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG-SLEEP ONLY,74000008,CDM,740,RC,95822,HCPCS,facility,both,,,,1212.72,1212.72,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG; CEREBRAL SILENCE,74000009,CDM,740,RC,95824,HCPCS,facility,both,,,,1335.36,1335.36,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG 16/> CH; EA 24 HRS,74000010,CDM,740,RC,95951,HCPCS,facility,both,,,,4254,4254,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC POLYSOM <6 YRS 4> PARAMETERS,74000060,CDM,740,RC,95782,HCPCS,facility,both,,,,3420.15,3420.15,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC POLYSOM <6 YRS CPAP/BILVL,74000061,CDM,740,RC,95783,HCPCS,facility,both,,,,3883.44,3883.44,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC SLEEP STUDY - UNATTD, SIMULT REC & SLEEP TIME",74000062,CDM,740,RC,95800,HCPCS,facility,both,,,,408.79,408.79,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC SLEEP STUDY - UNATTENDED, SIMULTANEOUS  RECORDING",74000063,CDM,740,RC,95801,HCPCS,facility,both,,,,163.51,163.51,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC SLEEP STUDY UNATTENDED & RESP EFFORT,74000064,CDM,740,RC,95806,HCPCS,facility,both,,,,408.79,408.79,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC ELECTROCORTICOGRAM AT SURGERY,74000067,CDM,740,RC,95829,HCPCS,facility,both,,,,6063.62,6063.62,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS,74000068,CDM,740,RC,95700,HCPCS,facility,both,,,,122.64,122.64,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED,74000069,CDM,740,RC,95705,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR,74000070,CDM,740,RC,95706,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS REAL-TIME MNTR,74000071,CDM,740,RC,95707,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED,74000072,CDM,740,RC,95708,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR,74000073,CDM,740,RC,95709,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EEG W/O VID TECH EA INCR 12-26 HR CONT REAL-TIME MNTR,74000074,CDM,740,RC,95710,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC VEEG BY TECH 2-12 HOURS UNMONITORED,74000075,CDM,740,RC,95711,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING,74000076,CDM,740,RC,95712,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC VEEG BY TECH 2-12 HR CONTINUOUS REAL-TIME MONITORING,74000077,CDM,740,RC,95713,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED,74000078,CDM,740,RC,95714,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR,74000079,CDM,740,RC,95715,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC VEEG BY TECH EA INCR 12-26 HR CONT REAL-TIME MNTR,74000080,CDM,740,RC,95716,HCPCS,facility,both,,,,2030.29,2030.29,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC GI STUDIES PRICE PER MINUTE ORC,75000001,CDM,750,RC,,,facility,both,,,,48.03,48.03,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC ESOPHAGUS MOTILITY STUDY,75000102,CDM,750,RC,,,facility,both,,,,603.6,603.6,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC ESOPHAGUS MOTILITY STUDY,75000102,CDM,750,RC,,,facility,both,,,,382.8,382.8,,,,,,,,,,,,,Gross Charge Type: BMC 40 OR
HC GASTROESOPHAGEAL REFLUX TEST,75000103,CDM,750,RC,,,facility,both,,,,382.8,382.8,,,,,,,,,,,,,Gross Charge Type: BMC 40 OR
HC GASTROESOPHAGEAL REFLUX TEST,75000103,CDM,750,RC,,,facility,both,,,,603.6,603.6,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC ANORECTAL MANOMETRY,75000106,CDM,750,RC,,,facility,both,,,,382.8,382.8,,,,,,,,,,,,,Gross Charge Type: BMC 40 OR
HC ANORECTAL MANOMETRY,75000106,CDM,750,RC,,,facility,both,,,,603.6,603.6,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC COLLECTION OF BLOOD VIA VAD,76100001,CDM,761,RC,36591,HCPCS,facility,both,,,,528.43,528.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC COLLECTION OF BLOOD VIA PICC,76100002,CDM,761,RC,36592,HCPCS,facility,both,,,,594.49,594.49,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC DECLOTTING VAD OR CATHETER,76100003,CDM,761,RC,36593,HCPCS,facility,both,,,,660.54,660.54,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ARTHROCENTESIS MAJOR JOINT OR BURSA,76100030,CDM,761,RC,20610,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC LARYNGOSCOPY FLEX; DIAGNOSTIC,76100033,CDM,761,RC,31575,HCPCS,facility,both,,,,528.54,528.54,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC LARYNGOSCOPY W/STROBOSCOPY,76100034,CDM,761,RC,31579,HCPCS,facility,both,,,,717.32,717.32,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
HC HARVEST STEM CELL CONCENTRATE,76100050,CDM,761,RC,38215,HCPCS,facility,both,,,50,572.67,572.67,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure
HC ABD PARACENTESIS W/IMAGING,76100064,CDM,761,RC,49083,HCPCS,facility,both,,,,1479.75,1479.75,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC; W/O IMG,76100108,CDM,761,RC,62270,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DRAIN CEREBRO SPINAL FLUID; W/O IMG,76100109,CDM,761,RC,62272,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC INTRAVITREAL INJECTION OF DRUG,76100113,CDM,761,RC,67028,HCPCS,facility,both,,,,240.11,240.11,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC GI TRACT CAPSULE ENDOSCOPY,76100116,CDM,761,RC,91110,HCPCS,facility,both,,,,1440.63,1440.63,,,,,,,,,,,,,Gross Charge Type: BMC 79 CLINIC ORC
HC THERAPEUTIC APHERESIS,76100118,CDM,761,RC,36514,HCPCS,facility,both,,,,3302.69,3302.69,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC APPLY MULTI-LAYER COMPRESSION LOWER LEG,76100150,CDM,761,RC,29581,HCPCS,facility,both,,,,417.43,417.43,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC APPLY MULTI-LAYER COMPRESSION LOWER LEG,76100150,CDM,761,RC,29581,HCPCS,facility,both,,,50,417.43,417.43,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure
HC APPLY MULTI-LAYER COMPRESSION LOWER LEG,76100150,CDM,761,RC,29581,HCPCS,facility,both,,,50,302.25,302.25,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure
HC APPLY MULTI-LAYER COMPRESSION LOWER LEG,76100150,CDM,761,RC,29581,HCPCS,facility,both,,,,302.25,302.25,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC ASPIRATE PLEURA W/IMAGING,76100156,CDM,761,RC,32555,HCPCS,facility,both,,,,1479.75,1479.75,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CHEMODENERV MUSC MIGRAINE,76100400,CDM,761,RC,64615,HCPCS,facility,both,,,,446.25,446.25,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC PERC VERTEBROPLASTY INJ, CERVICOTHORACIC",76100401,CDM,761,RC,22510,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC PERC VERTEBROPLASTY INJ, LUMBOSACRAL",76100402,CDM,761,RC,22511,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC PERC VERTEBROPLASTY INJ, EA ADDL",76100403,CDM,761,RC,22512,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC PERQ VERTEBRAL AUGMENTATION, THORACIC",76100404,CDM,761,RC,22513,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC PERQ VERTEBRAL AUGMENTATION, LUMBAR",76100405,CDM,761,RC,22514,HCPCS,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC PERC SACRAL AUGUMENTATION, UNIL INJ",76100407,CDM,761,RC,,,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
"HC PERC SACRAL AUGUMENTATION, BILAT INJ",76100408,CDM,761,RC,,,facility,both,,,,411.6,411.6,,,,,,,,,,,,,Gross Charge Type: BMC 48 CAT
HC DRAIN/INJ MAJOR JOINT/BURSA W/US,76100409,CDM,761,RC,20611,HCPCS,facility,both,,,,1479.75,1479.75,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC MYELOGRAPHY LUMBAR INJECTION; CERVICAL,76100410,CDM,761,RC,62302,HCPCS,facility,both,,,,1183.8,1183.8,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC MYELOGRAPHY LUMBAR INJECTION; THORACIC,76100411,CDM,761,RC,62303,HCPCS,facility,both,,,,1183.8,1183.8,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC MYELOGRAPHY LUMBAR INJECTION; LUMBOSACRAL,76100412,CDM,761,RC,62304,HCPCS,facility,both,,,,1183.8,1183.8,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC MYELOGRAPHY LUMBAR INJECTION; 2 OR MORE REGIONS,76100413,CDM,761,RC,62305,HCPCS,facility,both,,,,1775.7,1775.7,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS",76100427,CDM,761,RC,47531,HCPCS,facility,both,,,,591.9,591.9,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC HOSPITAL OBSERVATION SERVICE PER HR,76200001,CDM,762,RC,,,facility,both,,,,88.31,88.31,,,,,,,,,,,,,Gross Charge Type: BMC 80 ALL OBSERVATION
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE",77100001,CDM,771,RC,90471,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE",77100001,CDM,771,RC,90471,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL",77100002,CDM,771,RC,90472,HCPCS,facility,both,,,,10.8,10.8,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL",77100002,CDM,771,RC,90472,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE",77100003,CDM,771,RC,90473,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE",77100003,CDM,771,RC,90473,HCPCS,facility,both,,,,16.73,16.73,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC VACCINE ADMINISTRATION, FLU",77100004,CDM,771,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC VACCINE ADMINISTRATION, FLU",77100004,CDM,771,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC VACCINE ADMINISTRATION, PNEUMONIA",77100005,CDM,771,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC VACCINE ADMINISTRATION, PNEUMONIA",77100005,CDM,771,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC VACCINE ADMINISTRATION, HEP B",77100006,CDM,771,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC VACCINE ADMINISTRATION, HEP B",77100006,CDM,771,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL",77100007,CDM,771,RC,90474,HCPCS,facility,both,,,,10.8,10.8,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL",77100007,CDM,771,RC,90474,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY",77100008,CDM,771,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY",77100008,CDM,771,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY",77100008,CDM,771,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER D REGULATED GROUP A
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY",77100008,CDM,771,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER B REGULATED GROUP A
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY",77100008,CDM,771,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 1ST DOSE,77100009,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 2ND DOSE,77100010,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 100MCG/0.5ML 1ST DOSE,77100011,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 2ND DOSE,77100012,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 1ST DOSE",77100013,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 2ND DOSE",77100014,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 11/01/2023 HC ADM SARSCOV2 VAC AD26 /.5ML, SINGLE DOSE",77100015,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 5 MCG/0.5 ML 1ST DOSE,77100016,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 5 MCG/0.5 ML 2ND DOSE,77100017,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 3RD,77100018,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 3RD DOSE,77100019,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 50MCG/0.25ML; BOOSTER DOSE,77100020,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML; BOOSTER DOSE,77100021,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 1ST DOSE,77100022,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 2ND DOSE,77100023,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC SARSCOV2 VAC AD26 .5ML BOOSTER,77100024,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2025 HC TIXAGEVIMAB & CILGAVIMAB, INCL INJ & POST ADMIN MONITORING",77100025,CDM,771,RC,,,facility,both,,,,148.86,148.86,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 1ST DOSE,77100026,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 2ND DOSE,77100027,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 3RD DOSE,77100028,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; BOOSTER,77100029,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2025 HC IV INFUSION SOTROVIMAB, INCL INFUSION & POST ADMIN MONITORING",77100030,CDM,771,RC,,,facility,both,,,,445.11,445.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2025 HC BEBTELOVIMAB,INCLU INJECTION & POST ADMIN MONITORING",77100031,CDM,771,RC,,,facility,both,,,,346.69,346.69,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML BOOSTER DOSE,77100032,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 10 MCG/0.2 ML TRIS-SUCROSE BOOSTER,77100033,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-1ST DOSE,77100034,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-2 DOSE,77100035,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-3 DOSE,77100036,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 1ST DOSE,77100037,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 2ND DOSE,77100038,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11,77100039,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11,77100040,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11,77100041,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMM ADM SARSCOV2 25 MCG/0.25 ML 3RD DOSE,77100043,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 TRIS-SUCROSE - 3RD DOSE,77100044,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML BOOSTER,77100045,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 10 MCG/0.2 ML BOOSTER,77100046,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 50 MCG/0.5 ML BOOSTER,77100047,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML BOOSTER,77100048,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE,77100049,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE,77100050,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 3RD DOSE,77100051,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCV2 BVL 30MCG/0.3ML 1ST DOSE,77100052,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SRSCV2 BVL 25MCG/0.25ML 1ST DOSE,77100053,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SRSCV2 BVL 25 MCG/0.25ML 2ND DOSE,77100054,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCV2 BVL 10 MCG/0.2ML 1ST DOSE,77100055,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 1ST DOSE,77100056,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 2ND DOSE,77100057,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2ML ADDL DOSE,77100058,CDM,771,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC IMM ADMN SARSCOV2 VACCINE, SINGLE DOSE",77100059,CDM,771,RC,90480,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ADM RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP,77100060,CDM,771,RC,96380,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ADM RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX,77100061,CDM,771,RC,96381,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN",78000002,CDM,420,RC,98970,HCPCS,facility,both,,,,13.57,13.57,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN",78000002,CDM,420,RC,98970,HCPCS,facility,both,,,,15.54,15.54,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN",78000002,CDM,420,RC,98970,HCPCS,facility,both,,,,19.91,19.91,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN",78000003,CDM,420,RC,98971,HCPCS,facility,both,,,,13.57,13.57,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN",78000003,CDM,420,RC,98971,HCPCS,facility,both,,,,15.54,15.54,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN",78000003,CDM,420,RC,98971,HCPCS,facility,both,,,,19.91,19.91,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN",78000004,CDM,420,RC,98972,HCPCS,facility,both,,,,27.14,27.14,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN",78000004,CDM,420,RC,98972,HCPCS,facility,both,,,,39.84,39.84,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN",78000004,CDM,420,RC,98972,HCPCS,facility,both,,,,31.09,31.09,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN",78000005,CDM,940,RC,98966,HCPCS,facility,both,,,,84.17,84.17,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER D REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN",78000005,CDM,940,RC,98966,HCPCS,facility,both,,,,28.42,28.42,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN",78000005,CDM,940,RC,98966,HCPCS,facility,both,,,,48.36,48.36,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN",78000005,CDM,940,RC,98966,HCPCS,facility,both,,,,54.67,54.67,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  11-20 MIN",78000006,CDM,940,RC,98967,HCPCS,facility,both,,,,54.67,54.67,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  11-20 MIN",78000006,CDM,940,RC,98967,HCPCS,facility,both,,,,48.36,48.36,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  11-20 MIN",78000006,CDM,940,RC,98967,HCPCS,facility,both,,,,28.42,28.42,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  21-30 MIN",78000007,CDM,940,RC,98968,HCPCS,facility,both,,,,56.82,56.82,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  21-30 MIN",78000007,CDM,940,RC,98968,HCPCS,facility,both,,,,96.72,96.72,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  21-30 MIN",78000007,CDM,940,RC,98968,HCPCS,facility,both,,,,109.33,109.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC INPATIENT HEMODIALYSIS,80100001,CDM,801,RC,,,facility,both,,,,1061.25,1061.25,,,,,,,,,,,,,Gross Charge Type: BMC 51 RENAL DIALYSIS
HC INPATIENT PERITONEAL (NON-CAPD),80200001,CDM,802,RC,,,facility,both,,,,1061.25,1061.25,,,,,,,,,,,,,Gross Charge Type: BMC 51 RENAL DIALYSIS
HC INPATIENT CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD),80300001,CDM,803,RC,,,facility,both,,,,1061.25,1061.25,,,,,,,,,,,,,Gross Charge Type: BMC 51 RENAL DIALYSIS
HC OTHER INPATIENT DIALYSIS,80900001,CDM,809,RC,,,facility,both,,,,1061.25,1061.25,,,,,,,,,,,,,Gross Charge Type: BMC 51 RENAL DIALYSIS
HC EMERGENCY DIALYSIS ESRD PT,82900001,CDM,829,RC,,,facility,both,,,,1061.25,1061.25,,,,,,,,,,,,,Gross Charge Type: BMC 51 RENAL DIALYSIS
"HC ALCOHOL AND/OR DRUG,  MEDICAL/SOMATIC (AMBULATORY)",90000003,CDM,900,RC,,,facility,both,,,,594.49,594.49,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC ALCOHOL AND/OR DRUG,  MEDICAL/SOMATIC (AMBULATORY)",90000003,CDM,900,RC,,,facility,both,,,,309.04,309.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
HC PSYCH DIAGNOSTIC EVALUATION,90000010,CDM,900,RC,90791,HCPCS,facility,both,,,,301.48,301.48,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCH DIAGNOSTIC EVALUATION,90000010,CDM,900,RC,90791,HCPCS,facility,both,,,,701.17,701.17,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCH DIAGNOSTIC EVALUATION,90000010,CDM,900,RC,90791,HCPCS,facility,both,,,,412.06,412.06,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
HC PSYCH DIAG EVAL W/MED SRVCS,90000020,CDM,900,RC,90792,HCPCS,facility,both,,,,301.48,301.48,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCH DIAG EVAL W/MED SRVCS,90000020,CDM,900,RC,90792,HCPCS,facility,both,,,,876.44,876.44,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCHOTHERAPY CRISIS EA ADDL 30 MIN,90000021,CDM,900,RC,90840,HCPCS,facility,both,,,,97.89,97.89,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY CRISIS EA ADDL 30 MIN,90000021,CDM,900,RC,90840,HCPCS,facility,both,,,,292.12,292.12,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC INTENSIVE OUTPATIENT PSYCH PER DAY,90500001,CDM,905,RC,,,facility,both,,,,578.59,578.59,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER B REGULATED GROUP A
"HC PSYCHOSOCIAL REHAB SVC, PER DIEM, 2 VISITS/MONTH",91100001,CDM,911,RC,,,facility,both,,,,386.32,386.32,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC PSYCHOSOCIAL REHAB SVC, PER DIEM, 2 VISITS/MONTH",91100001,CDM,911,RC,,,facility,both,,,,386.32,386.32,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC ALCOHOL AND/OR DRUG SCREENING,91100002,CDM,911,RC,,,facility,both,,,,97.65,97.65,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCH REHAB  FULL DAY,91100003,CDM,911,RC,,,facility,both,,,,103.51,103.51,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER D REGULATED GROUP A
HC PSYCH REHAB  HALF DAY,91100004,CDM,911,RC,,,facility,both,,,,57.16,57.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER D REGULATED GROUP A
HC PSYCH REHAB ASSESSMENT,91100005,CDM,911,RC,,,facility,both,,,,700,700,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCH REHAB ASSESSMENT,91100005,CDM,911,RC,,,facility,both,,,,797,797,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCH REHAB ASSESSMENT,91100005,CDM,911,RC,,,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER D REGULATED GROUP A
"HC PSYCHOSOCIAL REHAB SVC, PER DIEM, 5 VISITS/MONTH",91100006,CDM,911,RC,,,facility,both,,,,794.82,794.82,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC PSYCHOSOCIAL REHAB SVC, PER DIEM, 5 VISITS/MONTH",91100006,CDM,911,RC,,,facility,both,,,,794.82,794.82,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC INVESTIGATIVE ASSESSMENT COMPLETION,91100007,CDM,911,RC,,,facility,both,,,,680,680,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCH STATUS REPORT,91400011,CDM,914,RC,90889,HCPCS,facility,both,,,,32.38,32.38,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT 30 MINUTES,91400050,CDM,914,RC,90832,HCPCS,facility,both,,,,292.12,292.12,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCHOTHERAPY PT 30 MINUTES,91400050,CDM,914,RC,90832,HCPCS,facility,both,,,,93.81,93.81,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT W/E&M 30 MIN,91400052,CDM,914,RC,90833,HCPCS,facility,both,,,,93.81,93.81,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT W/E&M 30 MIN,91400052,CDM,914,RC,90833,HCPCS,facility,both,,,,292.12,292.12,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCHOTHERAPY PT 45 MINUTES,91400055,CDM,914,RC,90834,HCPCS,facility,both,,,,350.57,350.57,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCHOTHERAPY PT 45 MINUTES,91400055,CDM,914,RC,90834,HCPCS,facility,both,,,,166.73,166.73,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT W/E&M 45 MIN,91400060,CDM,914,RC,90836,HCPCS,facility,both,,,,166.73,166.73,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT W/E&M 45 MIN,91400060,CDM,914,RC,90836,HCPCS,facility,both,,,,350.57,350.57,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCHOTHERAPY PT 60 MINUTES,91400061,CDM,914,RC,90837,HCPCS,facility,both,,,,166.73,166.73,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT 60 MINUTES,91400061,CDM,914,RC,90837,HCPCS,facility,both,,,,525.88,525.88,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC PSYCHOTHERAPY PT W/E&M 60 MIN,91400062,CDM,914,RC,90838,HCPCS,facility,both,,,,166.73,166.73,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PSYCHOTHERAPY PT W/E&M 60 MIN,91400062,CDM,914,RC,90838,HCPCS,facility,both,,,,525.88,525.88,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC PSYCHOTHERAPY  CRISIS,  INITIAL 60 MIN",91400063,CDM,914,RC,90839,HCPCS,facility,both,,,,187.59,187.59,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC PSYCHOTHERAPY  CRISIS,  INITIAL 60 MIN",91400063,CDM,914,RC,90839,HCPCS,facility,both,,,,525.88,525.88,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT,91400064,CDM,949,RC,96156,HCPCS,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; 1ST 30 MIN,91400065,CDM,949,RC,96158,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; EA ADDL 15 MIN,91400066,CDM,949,RC,96159,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC GROUP PSYCHOTHERAPY,91500001,CDM,915,RC,90853,HCPCS,facility,both,,,,64.81,64.81,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC GROUP PSYCHOTHERAPY,91500001,CDM,915,RC,90853,HCPCS,facility,both,,,,116.84,116.84,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE; 1ST 30 MIN,91500004,CDM,949,RC,96164,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE;  EA ADDL 15 MIN,91500005,CDM,949,RC,96165,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC FAMILY THERAPY W/O PATIENT; 50 MIN,91600001,CDM,916,RC,90846,HCPCS,facility,both,,,,165.03,165.03,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC FAMILY THERAPY W/O PATIENT; 50 MIN,91600001,CDM,916,RC,90846,HCPCS,facility,both,,,,233.72,233.72,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC FAMILY THERAPY W/PATIENT; 50 MIN,91600002,CDM,916,RC,90847,HCPCS,facility,both,,,,233.72,233.72,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC FAMILY THERAPY W/PATIENT; 50 MIN,91600002,CDM,916,RC,90847,HCPCS,facility,both,,,52,92.95,92.95,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services
HC FAMILY THERAPY W/PATIENT; 50 MIN,91600002,CDM,916,RC,90847,HCPCS,facility,both,,,,170.57,170.57,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC MULTI-FAMILY GROUP THERAPY,91600005,CDM,916,RC,90849,HCPCS,facility,both,,,,140.96,140.96,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE;  1ST 30 MIN,91600006,CDM,949,RC,96167,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE; EA ADD 15 MIN,91600007,CDM,949,RC,96168,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; 1ST 30 MIN,91600008,CDM,949,RC,96170,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; EA ADDL 15,91600009,CDM,949,RC,96171,HCPCS,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC BIOFEEDBACK TRAINING W/EMG,91700001,CDM,917,RC,90911,HCPCS,facility,both,,,,1277.4,1277.4,,,,,,,,,,,,,Gross Charge Type: BMC 40 OR
HC BIOFEEDBACK TRAINING W/EMG,91700001,CDM,917,RC,90911,HCPCS,facility,both,,,,108.22,108.22,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC BIOFEEDBACK TRAINING W/EMG,91700001,CDM,917,RC,90911,HCPCS,facility,both,,,,92.82,92.82,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC BIOFEEDBACK TRAINING BY ANY MODALITY,91700050,CDM,917,RC,90901,HCPCS,facility,both,,,,159.02,159.02,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC BIOFEEDBACK TRAINING BY ANY MODALITY,91700050,CDM,917,RC,90901,HCPCS,facility,both,,,,115.14,115.14,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT,91700051,CDM,917,RC,90912,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT,91700051,CDM,917,RC,90912,HCPCS,facility,both,,,,298.17,298.17,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT,91700052,CDM,917,RC,90913,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT,91700052,CDM,917,RC,90913,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC PSYCH TESTING, PER HR, PSYCH",91800001,CDM,918,RC,96101,HCPCS,facility,both,,,,767.04,767.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC PSYCH TESTING EVALUATION PHYSICIAN/HEALTH PROF, FIRST HR",91800021,CDM,918,RC,96130,HCPCS,facility,both,,,,467.47,467.47,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC PSYCH TESTING EVALUATION  PHYSICIAN/HEALTH PROF, EA ADDL HR",91800022,CDM,918,RC,96131,HCPCS,facility,both,,,,350.57,350.57,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC PSYCH/NEUROPSYCH TEST, TWO/MORE, FIRST 30 MIN, TECH",91800023,CDM,918,RC,96138,HCPCS,facility,both,,,,383.52,383.52,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC PSYCH/NEUROPSYCH TEST, TWO/MORE, EA ADDL 30 MIN, TECH",91800024,CDM,918,RC,96139,HCPCS,facility,both,,,,383.52,383.52,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC PSYCH/NEUROPSYCH TESTING, SINGLE AUTOMATED  RESULT",91800025,CDM,918,RC,96146,HCPCS,facility,both,,,,58.43,58.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC NEUROPSYCH TESTING EVALUATION, PHYS/HEALTH PROF; FIRST HOUR",91800028,CDM,918,RC,96132,HCPCS,facility,both,,,,701.17,701.17,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC NEUROPSYCH TESTING EVALUATION, PHYS/HEALTH PROF; EA ADDL HR",91800029,CDM,918,RC,96133,HCPCS,facility,both,,,,525.88,525.88,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC NEUROPSYCH TEST, TWO/MORE, FIRST 30 MIN, PHYS/ HEALTH PROF",91800030,CDM,918,RC,96136,HCPCS,facility,both,,,,409.03,409.03,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC NEUROPSYCH TEST, TWO/MORE, EA ADDL 30 MINS, PHYS/HEALTH PROF",91800031,CDM,918,RC,96137,HCPCS,facility,both,,,,409.03,409.03,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
"HC NEUROBEHAVIORAL STATUS EXAM, EA ADDL HR, PHYS/ HEALTH PROF",91800032,CDM,918,RC,96121,HCPCS,facility,both,,,,767.04,767.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT W/SCORING & DOCUMENTATION,91800033,CDM,918,RC,96127,HCPCS,facility,both,,,,58.42,58.42,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER A REGULATED GROUP A
HC CASE MGMT EACH 15 MIN,91900001,CDM,919,RC,,,facility,both,,,,172.13,172.13,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC PT EDUCATION, NOC,  NON-PHYSICIAN, INDIV/SESSION",91900002,CDM,919,RC,,,facility,both,,,,170.57,170.57,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC PT EDUCATION, NOC,  NON-PHYSICIAN, INDIV/SESSION",91900002,CDM,919,RC,,,facility,both,,,52,170.57,170.57,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services
"HC SUPPORT TO MAINTAIN EMPLOYMENT, PER DIEM",91900003,CDM,919,RC,,,facility,both,,,,554.35,554.35,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC SUPPORT TO MAINTAIN EMPLOYMENT, PER DIEM",91900003,CDM,919,RC,,,facility,both,,,21,682.26,682.26,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS | The modified price is presented in the standard charge value. | Modifier 21: Prolonged Evaluation and Management Services
"HC COORDINATED CARE FEE, RISK ADJ MAINT, LEVEL 4",91900004,CDM,919,RC,,,facility,both,,,,2854.65,2854.65,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC COORDINATED CARE FEE, RISK ADJ MAINT, LEVEL 4",91900004,CDM,919,RC,,,facility,both,,,,2675.79,2675.79,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC COORDINATED CARE FEE, RISK ADJ MAINT, LEVEL 5",91900005,CDM,919,RC,,,facility,both,,,,2854.65,2854.65,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC COORDINATED CARE FEE, RISK ADJ MAINT, LEVEL 5",91900005,CDM,919,RC,,,facility,both,,,,2675.79,2675.79,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC COMPREHENSIVE COMMUNITY SUPPORT SVC/DIEM,91900006,CDM,919,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC SUPPORTED EMPLOYMENT, PER DIEM",91900007,CDM,919,RC,,,facility,both,,,21,1703.93,1703.93,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS | The modified price is presented in the standard charge value. | Modifier 21: Prolonged Evaluation and Management Services
"HC SUPPORTED EMPLOYMENT, PER DIEM",91900007,CDM,919,RC,,,facility,both,,,,682.26,682.26,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC HEALTH HOME INTAKE,91900008,CDM,919,RC,,,facility,both,,,,127.21,127.21,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC HEALTH HOME MONTHLY,91900009,CDM,919,RC,,,facility,both,,,,127.21,127.21,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC MH SVC PLAN DEVELOP BY NON-PHYSICIAN,91900015,CDM,919,RC,,,facility,both,,,,131.35,131.35,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC MH SVC PLAN DEVELOP BY NON-PHYSICIAN,91900015,CDM,919,RC,,,facility,both,,,,426.38,426.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER C REGULATED GROUP A
HC PRE-VOCATIONAL PRE-PLACEMENT TRAINING,91900016,CDM,919,RC,,,facility,both,,,,225,225,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC PRE-VOCATIONAL PRE-PLACEMENT TRAINING,91900016,CDM,919,RC,,,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC JOB SHADOW PLACEMENT COACHING,91900017,CDM,919,RC,,,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC ON-GOING JOB COACHING EACH 15 MINUTES,91900018,CDM,919,RC,,,facility,both,,,,17.5,17.5,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC WORK ADJUSTMENT TRAINING PER WEEK,91900019,CDM,919,RC,,,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC WORK ADJUSTMENT TRAINING PER WEEK,91900019,CDM,919,RC,,,facility,both,,,,500,500,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC VIRTUAL WAT (PER PERSON/PER WEEK),91900020,CDM,919,RC,,,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC WORK FORCE LITERACY (WEEK/PER STUDENT),91900021,CDM,919,RC,,,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC EXPLORE WORKS (PER STUDENT/PER LESSON),91900022,CDM,919,RC,,,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC VIRTUAL WORK-BASED LEARNING EXPERIENCE - PER WEEK,91900023,CDM,919,RC,,,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC EX-OFFENDER,91900024,CDM,919,RC,,,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC RAPID JOB PLACEMENT,91900025,CDM,919,RC,,,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC 25% ABOVE MINIMUM WAGE,91900026,CDM,919,RC,,,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC SPECIALIZED DISABILITY POPULATIONS,91900027,CDM,919,RC,,,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC SPECIALIZED OCCUPATIONAL AREAS - STEM,91900028,CDM,919,RC,,,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC SUPPORTED EMPLOYMENT, PER 15 MINUTES",91900029,CDM,919,RC,,,facility,both,,,,11.72,11.72,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC DETERMINATION OF REFRACTIVE STATE,92000001,CDM,920,RC,92015,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
HC GONIOSCOPY,92000002,CDM,920,RC,92020,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC BINOCULAR VISION EXAM, I&R",92000003,CDM,920,RC,92060,HCPCS,facility,both,,,,528.43,528.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ORTHOPTIC TRAINING,92000004,CDM,920,RC,92065,HCPCS,facility,both,,,,660.54,660.54,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC  INTERMEDIATE VISUAL FIELD EXAM,92000005,CDM,920,RC,92082,HCPCS,facility,both,,,,528.43,528.43,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC EXTENDED, VISUAL FIELD EXAM(S), UNIL OR BIL",92000006,CDM,920,RC,92083,HCPCS,facility,both,,,,726.59,726.59,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, OPTIC NERVE",92000007,CDM,920,RC,92133,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC OPHTHALMOSCOPY EXTENDED, INITIAL",92000008,CDM,920,RC,92225,HCPCS,facility,both,,,,136.36,136.36,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC OPHTHALMOSCOPY EXTENDED, SUBSEQ",92000009,CDM,920,RC,92226,HCPCS,facility,both,,,,136.36,136.36,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC PM/ICD REMOTE TECH SERV =<90 DAYS,92000015,CDM,920,RC,93296,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC INTERROGATION VAD IN PERSON,92000016,CDM,920,RC,93750,HCPCS,facility,both,,,,241.09,241.09,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC SLS-EPS; PERIPH NRV; UPPER LIMBS,92000020,CDM,920,RC,95925,HCPCS,facility,both,,,,422.41,422.41,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC SLS-EPS; PERIPH NRV; LOWER LIMBS,92000021,CDM,920,RC,95926,HCPCS,facility,both,,,,408.79,408.79,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC CENTRAL MOTOR EVOKED UPP LIMBS,92000022,CDM,920,RC,95928,HCPCS,facility,both,,,,504.17,504.17,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC CENTRAL MOTOR EVOKED LWR LIMBS,92000023,CDM,920,RC,95929,HCPCS,facility,both,,,,531.41,531.41,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC BLINK TEST,92000024,CDM,920,RC,95933,HCPCS,facility,both,,,,177.14,177.14,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC ANALYZE NEUROSTIM SIMPLE,92000060,CDM,920,RC,95971,HCPCS,facility,both,,,,327.99,327.99,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC IONM IN OPERATNG ROOM 15 MIN,92000070,CDM,920,RC,95940,HCPCS,facility,both,,,,40.88,40.88,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC IONM REMOTE/>1 PT OR PER HR,92000071,CDM,920,RC,95941,HCPCS,facility,both,,,,40.88,40.88,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, ANTERIOR  SEGMENT",92000074,CDM,920,RC,92132,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, RETINA",92000075,CDM,920,RC,92134,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC  GLUCOSE MONITORING CONT 72+ HRS - PROVIDED EQUIPMENT,92000076,CDM,920,RC,95250,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC COMPUTERIZED  CORNEAL TOPOGRAPHY,92000077,CDM,920,RC,92025,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OPHTHALMIC BIOMETRY,92000078,CDM,920,RC,92136,HCPCS,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC FLUORESCEIN ANGIOGRAPHY, UNIL OR BIIL",92000079,CDM,920,RC,92235,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC INDOCYANINE-GREEN ANGIOGRAPHY, UNIL OR BIL",92000080,CDM,920,RC,92240,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC FUNDUS PHOTOGRAPHY,92000081,CDM,920,RC,92250,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC SLIT LAMP PHOTOGRAPHY (EXT),92000084,CDM,920,RC,92285,HCPCS,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC INTERNAL EYE PHOTOGRAPHY,92000085,CDM,920,RC,92286,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC RX CONTACT; CORNEAL BOTH EYES,92000086,CDM,920,RC,92310,HCPCS,facility,both,,,,109.33,109.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC BINOCULAR MICROSCOPY,92000090,CDM,920,RC,92504,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC FLUORESCEIN & INDOCYAN ANGIO, SAME ENCOUNTER",92000091,CDM,920,RC,92242,HCPCS,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI,92000097,CDM,920,RC,92201,HCPCS,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI,92000098,CDM,920,RC,92202,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC REMOTE INTERROG IMP CARD PHYS MONT SYS UP TO 30 DAYS,92000099,CDM,920,RC,93297,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
HC REMOTE INTERROG SUB CARD RHYM MONT SYS UP TO 30 DAYS,92000100,CDM,920,RC,93298,HCPCS,facility,both,,,,321.44,321.44,,,,,,,,,,,,,Gross Charge Type: BMC 43 EKG
"HC IMG RETINA DETECT/MONITOR DISEASE: POC AUTO A/R, UNIL/BILAT",92000103,CDM,920,RC,92229,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMG, POSTERIOR, RETINA, W/OCTA",92000108,CDM,920,RC,92137,HCPCS,facility,both,,,,726.59,726.59,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC CAROTID DUPLEX SCAN; BILAT,92100001,CDM,921,RC,93880,HCPCS,facility,both,,,,1938.93,1938.93,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC CAROTID DUPLEX SCAN; UNIL/LIMIT,92100002,CDM,921,RC,93882,HCPCS,facility,both,,,,1222.37,1222.37,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC INTRACRANIAL ARTERY DOPPLER; COMPL,92100003,CDM,921,RC,93886,HCPCS,facility,both,,,,2739.79,2739.79,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC INTRACRANIAL ARTERY DOPPLER; LIMITED,92100004,CDM,921,RC,93888,HCPCS,facility,both,,,,1475.28,1475.28,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UPR/L XTREMITY ART 2 LEVELS,92100005,CDM,921,RC,93922,HCPCS,facility,both,,,,885.16,885.16,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC UPR/LXTR ART STDY 3+ LVLS,92100006,CDM,921,RC,93923,HCPCS,facility,both,,,,1348.82,1348.82,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC LWR XTR VASC STDY BILAT,92100007,CDM,921,RC,93924,HCPCS,facility,both,,,,1728.18,1728.18,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX LE ART/BPG; BILAT,92100008,CDM,921,RC,93925,HCPCS,facility,both,,,,2613.33,2613.33,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX LE ART/BPG; UNIL/LIMIT,92100009,CDM,921,RC,93926,HCPCS,facility,both,,,,1517.42,1517.42,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX UE ART/BPG; BILAT,92100010,CDM,921,RC,93930,HCPCS,facility,both,,,,1981.08,1981.08,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX UE ART/BPG; UNIL/LIMIT,92100011,CDM,921,RC,93931,HCPCS,facility,both,,,,1222.37,1222.37,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX EXT VEINS; BILAT,92100012,CDM,921,RC,93970,HCPCS,facility,both,,,,1938.93,1938.93,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX EXT VEINS; UNIL/LIMIT,92100013,CDM,921,RC,93971,HCPCS,facility,both,,,,1180.22,1180.22,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX ARTERIAL FLOW; COMPL,92100014,CDM,921,RC,93975,HCPCS,facility,both,,,,2655.49,2655.49,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX ARTERIAL FLOW; LIMITED,92100015,CDM,921,RC,93976,HCPCS,facility,both,,,,282.6,282.6,,,,,,,,,,,,,Gross Charge Type: BMC 39 L&D
HC DUPLEX ARTERIAL FLOW; LIMITED,92100015,CDM,921,RC,93976,HCPCS,facility,both,,,,1475.28,1475.28,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX A IVC IL/BPG; COMPL,92100016,CDM,921,RC,93978,HCPCS,facility,both,,,,1812.48,1812.48,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX A IVC IL/BPG; UNIL/LIM,92100017,CDM,921,RC,93979,HCPCS,facility,both,,,,1138.07,1138.07,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX FLOW PENILE V; COMPL,92100018,CDM,921,RC,93980,HCPCS,facility,both,,,,716.56,716.56,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC DUPLEX HEMODIALYSIS ACCESS,92100019,CDM,921,RC,93990,HCPCS,facility,both,,,,1601.73,1601.73,,,,,,,,,,,,,Gross Charge Type: BMC 45 DIAGNOSTIC IMAGING
HC EMG- ONE EXTREMITY,92200001,CDM,922,RC,95860,HCPCS,facility,both,,,,272.52,272.52,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EMG-TWO EXTREMITIES,92200002,CDM,922,RC,95861,HCPCS,facility,both,,,,354.28,354.28,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EMG-THREE EXTREMITIES,92200003,CDM,922,RC,95863,HCPCS,facility,both,,,,449.66,449.66,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EMG CRANIAL NERVE - UNILAT,92200004,CDM,922,RC,95867,HCPCS,facility,both,,,,204.39,204.39,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EMG CRANIAL NERVE; BILAT,92200005,CDM,922,RC,95868,HCPCS,facility,both,,,,272.52,272.52,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC EMG THORACIC PARASPINAL,92200006,CDM,922,RC,95869,HCPCS,facility,both,,,,272.52,272.52,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC MUSCLE TEST NONPARASPINAL 1 EXT,92200007,CDM,922,RC,95870,HCPCS,facility,both,,,,272.52,272.52,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC EMG SNGL FIBER, ANY/ALL SITES",92200008,CDM,922,RC,95872,HCPCS,facility,both,,,,163.51,163.51,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NEUROMUSC JUNCTION TEST EA NRV,92200013,CDM,922,RC,95937,HCPCS,facility,both,,,,177.14,177.14,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 1-2,92200015,CDM,922,RC,95907,HCPCS,facility,both,,,,163.51,163.51,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 3-4,92200016,CDM,922,RC,95908,HCPCS,facility,both,,,,218.02,218.02,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 5-6,92200017,CDM,922,RC,95909,HCPCS,facility,both,,,,258.89,258.89,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 7-8,92200018,CDM,922,RC,95910,HCPCS,facility,both,,,,340.65,340.65,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 9-10,92200019,CDM,922,RC,95911,HCPCS,facility,both,,,,381.53,381.53,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 11-12,92200020,CDM,922,RC,95912,HCPCS,facility,both,,,,381.53,381.53,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NERVE CONDUCT STUDIES 13 OR MORE,92200021,CDM,922,RC,95913,HCPCS,facility,both,,,,422.41,422.41,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC VISUAL EVOKED POTENTIAL, CHECKERBD/FLASH TEST, CNS, EXCEPT GLAUCOMA",92200051,CDM,922,RC,95930,HCPCS,facility,both,,,,422.41,422.41,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
"HC VISUAL EVOKED POTENTIAL, CHECKERBD/FLASH TEST, CNS, EXCEPT GLAUCOMA",92200051,CDM,922,RC,95930,HCPCS,facility,both,,,,560.78,560.78,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC MUSCLE TEST DONE W/NERVE TEST LIMITED,92200052,CDM,922,RC,95885,HCPCS,facility,both,,,,149.88,149.88,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC MUSC TEST DONE W/NERVE TEST COMP,92200053,CDM,922,RC,95886,HCPCS,facility,both,,,,177.14,177.14,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC MUSC TEST DONE W/NERVE TEST NON EXTREMITY,92200054,CDM,922,RC,95887,HCPCS,facility,both,,,,163.51,163.51,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC GUIDE NERVE DESTRUCTION ELECTRICAL STIM,92200055,CDM,922,RC,95873,HCPCS,facility,both,,,,204.39,204.39,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC NEEDLE EMG; FOUR EXTREMITIES,92200056,CDM,922,RC,95864,HCPCS,facility,both,,,,531.41,531.41,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC SOMATOSENSORY TESTING; UPPER & LOWER LIMBS,92200057,CDM,922,RC,95938,HCPCS,facility,both,,,,1130.96,1130.96,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC CENTRAL MOTOR EVOKED UPPER & LOWER LIMBS,92200058,CDM,922,RC,95939,HCPCS,facility,both,,,,1471.62,1471.62,,,,,,,,,,,,,Gross Charge Type: BMC 44 EEG
HC PERCUTANEOUS ALLEGY SKIN TEST W/EXTRACT,92400001,CDM,924,RC,95004,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC PERQ & ICUT ALLG TEST VENOMS,92400010,CDM,924,RC,95017,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC PERQ&IC ALLG TEST DRUGS/BIOL,92400015,CDM,924,RC,95018,HCPCS,facility,both,,,,330.27,330.27,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC INGEST CHALLENGE INIITIAL 120 MIN,92400020,CDM,924,RC,95076,HCPCS,facility,both,,,,1255.02,1255.02,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC INGEST CHALLENGE ADDL 60 MIN,92400025,CDM,924,RC,95079,HCPCS,facility,both,,,,660.54,660.54,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC  PATCH OR APPLICATION TEST(S),92400026,CDM,924,RC,95044,HCPCS,facility,both,,,,66.05,66.05,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC OPHTHALMIC MUCOUS MEMBRANE TESTS,92400027,CDM,924,RC,95060,HCPCS,facility,both,,,,218.67,218.67,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC RAPID DESENSITIZATION, EACH HOUR",92400029,CDM,924,RC,95180,HCPCS,facility,both,,,,1255.02,1255.02,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC ALLERGEN IMMUNOTHERAPY, SINGLE INJ",94000001,CDM,940,RC,95115,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
HC PHOTOCHEMOTHERAPY UVB,94000003,CDM,940,RC,96910,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC PHOTOCHEMOTHERAPY UVB,94000003,CDM,940,RC,96910,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER D CLINIC ACUTE
HC PHOTOCHEMOTHERAPY PUVA,94000004,CDM,940,RC,96912,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER D CLINIC ACUTE
HC PHOTOCHEMOTHERAPY PUVA,94000004,CDM,940,RC,96912,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 7/1/2018 HCCPR PER 15 MIN,94000005,CDM,940,RC,92950,HCPCS,facility,both,,,,33.3,33.3,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC CONTACT LENS FITTING FOR TX,94000010,CDM,940,RC,92071,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC IMMUNOTHERAPY 2+ INJECTIONS,94000011,CDM,940,RC,95117,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
HC CPR PER SESSION,94000012,CDM,940,RC,92950,HCPCS,facility,both,,,,309.36,309.36,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC PHLEBOTOMY THERAPEUTIC,94030001,CDM,940,RC,99195,HCPCS,facility,both,,,,104.67,104.67,,,,,,,,,,,,,Gross Charge Type: BMC 42 LABS
HC PULMONARY REHAB MAINTENANCE PER MONTH,94090002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC DEFAULT UNREGULATED SERVICES
HC PULMONARY REHAB MAINTENANCE PER MONTH,94090002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC PULMONARY REHAB MAINTENANCE PER HALF MONTH,94090003,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC PULMONARY REHAB MAINTENANCE PER HALF MONTH,94090003,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC DEFAULT UNREGULATED SERVICES
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT",94200001,CDM,942,RC,97802,HCPCS,facility,both,,,,155.3,155.3,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT",94200001,CDM,942,RC,97802,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
"HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT",94200002,CDM,942,RC,97803,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
"HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT",94200002,CDM,942,RC,97803,HCPCS,facility,both,,,,73.68,73.68,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"DEAC 03/31/2022 HC DIABETES SELF MGMT, INDIV, EA 30 MIN",94200003,CDM,942,RC,,,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
"DEAC 03/31/2022 HC DIABETES SELF MGMT, INDIV, EA 30 MIN",94200003,CDM,942,RC,,,facility,both,,,,147.36,147.36,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC MNT, INDIV, EA 15 MIN, RE-ASSESS, 2ND REF",94200005,CDM,942,RC,,,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
"HC MNT, INDIV, EA 15 MIN, RE-ASSESS, 2ND REF",94200005,CDM,942,RC,,,facility,both,,,,73.68,73.68,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
DEAC 01/31/2022 HC DM OP SMT GRP PER 30 MIN,94200025,CDM,942,RC,,,facility,both,,,,136.23,136.23,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN",94200051,CDM,942,RC,97804,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
"HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN",94200051,CDM,942,RC,97804,HCPCS,facility,both,,,,98.24,98.24,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC SELF-MGMT EDUCATION & TRAIN, INDIV PT, EA 30 MINS",94200052,CDM,942,RC,98960,HCPCS,facility,both,,,,462.38,462.38,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC SELF-MGMT EDUCATION & TRAIN, INDIV PT, EA 30 MINS",94200052,CDM,942,RC,98960,HCPCS,facility,both,,,,22.5,22.5,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER C CLINIC ACUTE
"HC SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN",94200053,CDM,942,RC,98961,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN",94200053,CDM,942,RC,98961,HCPCS,facility,both,,,,22.5,22.5,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER C CLINIC ACUTE
"HC SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN",94200054,CDM,942,RC,98962,HCPCS,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN",94200054,CDM,942,RC,98962,HCPCS,facility,both,,,,22.5,22.5,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER C CLINIC ACUTE
HC SMOKING/TOBACCO CESSATION COUNSELING; GREATER THAN 3 UP TO 10 MIN,94200055,CDM,942,RC,99406,HCPCS,facility,both,,,,38.67,38.67,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
HC SMOKING/TOBACCO CESSATION COUNSELING; GREATER THAN 10 MIN,94200056,CDM,942,RC,99407,HCPCS,facility,both,,,,77.35,77.35,,,,,,,,,,,,,Gross Charge Type: BMC 49 RT
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN",94200057,CDM,942,RC,97550,HCPCS,facility,both,,,,119.27,119.27,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN",94200057,CDM,942,RC,97550,HCPCS,facility,both,,,,113.26,113.26,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN",94200057,CDM,942,RC,97550,HCPCS,facility,both,,,,86.36,86.36,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN",94200058,CDM,942,RC,97551,HCPCS,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN",94200058,CDM,942,RC,97551,HCPCS,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN",94200058,CDM,942,RC,97551,HCPCS,facility,both,,,,37.75,37.75,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS",94200059,CDM,942,RC,97552,HCPCS,facility,both,,,,75.51,75.51,,,,,,,,,,,,,Gross Charge Type: BMC 54 SPEECH THERAPY
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS",94200059,CDM,942,RC,97552,HCPCS,facility,both,,,,57.57,57.57,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS",94200059,CDM,942,RC,97552,HCPCS,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, INIT 30 MIN",94200061,CDM,942,RC,,,facility,both,,,,119.27,119.27,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, INIT 30 MIN",94200061,CDM,942,RC,,,facility,both,,,,86.36,86.36,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, EA ADDT'L 15 MIN",94200062,CDM,942,RC,,,facility,both,,,,28.79,28.79,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, EA ADDT'L 15 MIN",94200062,CDM,942,RC,,,facility,both,,,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
"HC GROUP CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, MULT SETS",94200063,CDM,942,RC,,,facility,both,,,,57.57,57.57,,,,,,,,,,,,,Gross Charge Type: BMC 53 OT
"HC GROUP CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, MULT SETS",94200063,CDM,942,RC,,,facility,both,,,,79.51,79.51,,,,,,,,,,,,,Gross Charge Type: BMC 52 PT
HC CARDIAC REHAB; W CONT ECG,94300003,CDM,943,RC,93798,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
HC CARDIAC REHAB; W CONT ECG,94300003,CDM,943,RC,93798,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
HC CARDIAC REHAB; W CONT ECG,94300003,CDM,943,RC,93798,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER C CLINIC ACUTE
HC CARDIAC REHAB; W CONT ECG,94300003,CDM,943,RC,93798,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER D CLINIC ACUTE
"HC PERIPHER ARTERY DISEASE (PAD) REHAB, PER SESS",94300006,CDM,943,RC,93668,HCPCS,facility,both,,,,264.22,264.22,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC CARDIAC REHAB MAINT PER MONTH,94390002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER D CLINIC ACUTE
HC CARDIAC REHAB MAINT PER MONTH,94390002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC DEFAULT UNREGULATED SERVICES
HC CARDIAC REHAB MAINT PER MONTH,94390002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
HC CARDIAC REHAB MAINT PER MONTH,94390002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER C CLINIC ACUTE
HC CARDIAC REHAB MAINT PER MONTH,94390002,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
HC CARDIAC REHAB MAINT PER HALF MONTH,94390005,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER A CLINIC ACUTE
HC CARDIAC REHAB MAINT PER HALF MONTH,94390005,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER C CLINIC ACUTE
HC CARDIAC REHAB MAINT PER HALF MONTH,94390005,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER D CLINIC ACUTE
HC CARDIAC REHAB MAINT PER HALF MONTH,94390005,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC 29 FIXED RATE FEES TIER B CLINIC ACUTE
HC CARDIAC REHAB MAINT PER HALF MONTH,94390005,CDM,999,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: BMC DEFAULT UNREGULATED SERVICES
HC ALCOHOL OR DRUG ASSESSMENT,94400001,CDM,944,RC,,,facility,both,,,,412.06,412.06,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
HC BEHAVIORAL HEALTH COUNSELING &THERAPY PER 15 MINS,94400002,CDM,944,RC,,,facility,both,,,,198.16,198.16,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC BEHAVIORAL HEALTH COUNSELING &THERAPY PER 15 MINS,94400002,CDM,944,RC,,,facility,both,,,,198.15,198.15,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
HC ALCOHOL/DRUG GROUP COUNSELING,94400003,CDM,944,RC,,,facility,both,,,,132.11,132.11,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ALCOHOL/DRUG GROUP COUNSELING,94400003,CDM,944,RC,,,facility,both,,,,132.09,132.09,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"HC METHADONE TREATMENT, WEEKLY",94400004,CDM,944,RC,,,facility,both,,,,309.04,309.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"HC METHADONE TREATMENT, WEEKLY",94400004,CDM,944,RC,,,facility,both,,,,309.04,309.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
HC ALCOHOL/DRUG INTENSIVE OP >3 HR/3 DAYS,94400005,CDM,944,RC,,,facility,both,,,,396.33,396.33,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
HC ALCOHOL/DRUG INTENSIVE OP >3 HR/3 DAYS,94400005,CDM,944,RC,,,facility,both,,,,396.3,396.3,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
HC MENTAL HEALTH ASSESSMENT NON PHYS,94400006,CDM,944,RC,,,facility,both,,,,172.13,172.13,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC ASSERTIVE COMMUNITY TX PGM PER DIEM,94400007,CDM,944,RC,,,facility,both,,,52,1019.98,1019.98,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services
HC ASSERTIVE COMMUNITY TX PGM PER DIEM,94400007,CDM,944,RC,,,facility,both,,,,1330.41,1330.41,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
"HC ALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOS",94400011,CDM,944,RC,,,facility,both,,,,309.04,309.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"HC ALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOS",94400011,CDM,944,RC,,,facility,both,,,,594.49,594.49,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
"HC MEDICATION ASSISTED TREATMENT, METHADONE; WEEKLY BUNDLE",94400014,CDM,944,RC,,,facility,both,,,,309.04,309.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"HC MEDICATION ASSISTED TREATMENT, BUPRENORPHINE(ORAL); WEEKLY BUNDLE",94400015,CDM,944,RC,,,facility,both,,,,309.04,309.04,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"HC INTAKE ACTIVITIES, INCLUDING MEDICAL EXAM",94400016,CDM,944,RC,,,facility,both,,,,412.06,412.06,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC PSY TIER E ( ATS)  REGULATED GROUP A
"DEAC 1/1/2022 HC PULMONARY REHAB, 1 HR, PER SESSION",94800001,CDM,948,RC,,,facility,both,,,,404.88,404.88,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC PULMONARY REHAB MAINTENANCE - HALF MONTH,94800002,CDM,948,RC,,,facility,both,,,,31.77,31.77,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
"HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR, PER SESSION",94800003,CDM,948,RC,94625,HCPCS,facility,both,,,,427.38,427.38,,,,,,,,,,,,,Gross Charge Type: BMC 50 PULMONARY FUNCTION
HC DORS NOC,99000017,CDM,990,RC,,,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC DORS NOC,99000017,CDM,990,RC,,,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC NO SHOW INVESTIGATIVE ASSESSMENT,99000019,CDM,990,RC,,,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: BMC UNREGULATED SPECIAL PROGRAMS
HC JSR TEST EXPLODE,99099999,CDM,990,RC,,,facility,both,,,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: BMC 29 CLINIC ACUTE
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,426812.43,348117.47,676260.89,1 through 10,percent of total billed charges,,,
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,463061.53,463061.53,463061.53,1 through 10,percent of total billed charges,,,
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,222766.38,222766.38,451091.44,1 through 10,percent of total billed charges,,,
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,445307,445307,445307,1 through 10,percent of total billed charges,,,
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,858471.32,858471.32,858471.32,1 through 10,percent of total billed charges,,,
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,436403.51,436403.51,436403.51,1 through 10,percent of total billed charges,,,
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,183085.91,183085.91,183085.91,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,404051.46,404051.46,404051.46,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,187082.36,187082.36,187082.36,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,292428.72,292428.72,292428.72,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,209606.56,209606.56,209606.56,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,386043.61,386043.61,386043.61,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,132426.47,132426.47,132426.47,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,264045.36,264045.36,264045.36,1 through 10,percent of total billed charges,,,
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,26735.89,26735.89,26735.89,1 through 10,percent of total billed charges,,,
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,104394.01,104394.01,104394.01,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,33178.21,33178.21,33178.21,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,68060.23,68060.23,68060.23,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,71244.21,71244.21,71244.21,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,80103.36,80103.36,80103.36,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,95444.01,95444.01,95444.01,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,119373.59,119373.59,119373.59,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,80786.24,80786.24,80786.24,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,203767.91,203767.91,203767.91,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,67282.29,67282.29,67282.29,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,188724.21,188724.21,188724.21,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,46044.72,46044.72,46044.72,1 through 10,percent of total billed charges,,,
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,57175.08,57175.08,57175.08,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,51288.4,51288.4,51288.4,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,68169.95,55977.45,88454.57,11,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,62493.41,54243.82,114855.74,11,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,47864.56,47864.56,47864.56,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,87835.48,87835.48,87835.48,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,118113.99,118113.99,118113.99,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,50475.8,44553.64,95085,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,90906.32,90906.32,123592.02,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,111733.65,111733.65,111733.65,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,62012.05,62012.05,62012.05,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,77216.51,77216.51,130350.71,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16678.45,16678.45,16678.45,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,54381.58,50251.63,80593.72,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,48514.17,45886.86,53871.64,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,60851.17,14889.14,73758.91,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,62544.27,62544.27,62544.27,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,62603.25,62603.25,62603.25,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18723.01,18723.01,18723.01,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,49196.59,49196.59,53270.4,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,25162.68,25162.68,25162.68,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,58249.68,58249.68,58249.68,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,50140.75,45068.28,50709.99,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,33997.18,21664.51,67898.23,13,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,47320.82,42840.98,82460.77,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,36630.56,36630.56,36630.56,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,52463.58,41093.11,54861.69,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11752.45,11752.45,11752.45,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,46287.6,46287.6,62737.92,1 through 10,percent of total billed charges,,,
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,74475.52,74475.52,74475.52,1 through 10,percent of total billed charges,,,
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,21992.3,21992.3,21992.3,1 through 10,percent of total billed charges,,,
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,141038.45,141038.45,141038.45,1 through 10,percent of total billed charges,,,
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,32439.39,32439.39,32439.39,1 through 10,percent of total billed charges,,,
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,31335.48,31335.48,31335.48,1 through 10,percent of total billed charges,,,
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,33648.72,33648.72,33648.72,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,38609.2,38609.2,38609.2,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29891.3,29891.3,29891.3,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,30219.11,30219.11,30219.11,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,53401.04,53401.04,72591.75,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,76774.25,76774.25,76774.25,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,42992.82,42992.82,42992.82,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,32078.76,32078.76,34332.37,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,17687.47,17687.47,17687.47,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,41998.96,41998.96,41998.96,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,33310.45,33310.45,33310.45,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,27797.73,27797.73,27797.73,1 through 10,percent of total billed charges,,,
Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,68276.11,68276.11,68276.11,1 through 10,percent of total billed charges,,,
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,37803.93,37803.93,37803.93,1 through 10,percent of total billed charges,,,
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,49124.15,49124.15,49124.15,1 through 10,percent of total billed charges,,,
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,52600.72,52600.72,52600.72,1 through 10,percent of total billed charges,,,
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,37136.15,37136.15,37136.15,1 through 10,percent of total billed charges,,,
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,82509.46,82509.46,82509.46,1 through 10,percent of total billed charges,,,
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,49651.21,49651.21,49651.21,1 through 10,percent of total billed charges,,,
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,133593.94,133593.94,133593.94,1 through 10,percent of total billed charges,,,
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,29387.4,29387.4,29387.4,1 through 10,percent of total billed charges,,,
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,51837.66,51837.66,51837.66,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,18772.35,18772.35,18772.35,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,19078.71,19078.71,19078.71,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7239.34,7239.34,7239.34,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,35425.99,35425.99,35425.99,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,14633.34,14633.34,14633.34,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,15184.99,15184.99,15184.99,1 through 10,percent of total billed charges,,,
Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12278.81,11387.65,82330.62,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,963.16,963.16,963.16,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,74393.43,67836.53,74904.14,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,22683.59,22683.59,22683.59,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,76617.76,76617.76,76617.76,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,18416.19,18416.19,18416.19,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,50942.65,42364.06,91312.96,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,15629.55,15629.55,15629.55,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17013.7,17013.7,17013.7,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,38977.79,38977.79,53084.71,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13178.52,13178.52,13178.52,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,41687.32,8570.26,89042.25,13,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,30504.52,5848.12,78877.21,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,38704.03,15111.17,89706.03,12,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,26167.15,7154.89,91665.33,11,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,8647.74,8647.74,44486.35,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,14299.48,14299.48,23084.79,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,14354.47,14354.47,14354.47,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,63985.93,31251.48,88699.74,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,74980.17,74980.17,127103.86,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,27506.67,9342.93,60632.51,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,108382.81,108382.81,108382.81,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,47022.85,11535.28,150490.37,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,60134.23,60134.23,65232.68,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,27541.72,13374.62,50308.92,1 through 10,percent of total billed charges,,,
Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,86533.87,86533.87,86533.87,1 through 10,percent of total billed charges,,,
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,29187.2,29187.2,29187.2,1 through 10,percent of total billed charges,,,
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29732.44,29732.44,29732.44,1 through 10,percent of total billed charges,,,
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,10095.06,10095.06,10095.06,1 through 10,percent of total billed charges,,,
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,15476.09,15476.09,15476.09,1 through 10,percent of total billed charges,,,
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,43700.89,43700.89,43700.89,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,24543.65,24543.65,24543.65,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,65696.61,65696.61,65696.61,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,25497.13,25497.13,25497.13,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25922.3,25922.3,25922.3,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,30763.28,30763.28,30763.28,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,27740,27740,27740,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,20662.78,20662.78,20662.78,1 through 10,percent of total billed charges,,,
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,117387.43,117387.43,117387.43,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,52615.85,28030.39,121640.96,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,38144.47,28754.92,58732.79,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,57020.75,23187.88,61835.89,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,50946.62,50946.62,50946.62,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,15245.96,15245.96,15245.96,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,19329.3,19329.3,30097.04,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,20567.29,20567.29,20567.29,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,45464.6,21962.77,81059.16,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,29742.63,29742.63,29742.63,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,31562.62,31562.62,45171.6,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,20728.22,16518.06,26536.82,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,36051.24,36051.24,36051.24,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,20742.65,10363.42,30605.97,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,15433.77,15433.77,15433.77,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,17497.03,6972.67,18016.76,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,45670.04,45670.04,45670.04,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,11311.38,11311.38,11311.38,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,19479.81,19479.81,19479.81,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,5330.46,5330.46,5330.46,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,10999.88,10999.88,10999.88,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,16667.09,6583.11,24666.22,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,16366.13,16366.13,19802.72,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,14962.01,14962.01,14962.01,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,7897.97,7897.97,7897.97,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,12313.41,12313.41,12313.41,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8498.4,8498.4,8498.4,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,19078.61,19078.61,19078.61,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7409.05,7409.05,7409.05,1 through 10,percent of total billed charges,,,
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12921.37,12921.37,12921.37,1 through 10,percent of total billed charges,,,
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10927.07,10927.07,10927.07,1 through 10,percent of total billed charges,,,
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6376.14,6376.14,6376.14,1 through 10,percent of total billed charges,,,
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,12078.92,12078.92,12078.92,1 through 10,percent of total billed charges,,,
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9110.23,9110.23,9110.23,1 through 10,percent of total billed charges,,,
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,5970.48,5970.48,5970.48,1 through 10,percent of total billed charges,,,
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10116.62,10116.62,10116.62,1 through 10,percent of total billed charges,,,
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5158.82,5158.82,5158.82,1 through 10,percent of total billed charges,,,
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,36903.16,36903.16,36903.16,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,34832.28,34832.28,34832.28,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9417.7,9417.7,9417.7,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,24276.57,24276.57,24276.57,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10473.51,10473.51,10473.51,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9897.41,9897.41,9897.41,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,16848.25,16848.25,16848.25,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,54350.89,54350.89,54350.89,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,11535.64,11535.64,11535.64,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,16856.77,16856.77,16856.77,1 through 10,percent of total billed charges,,,
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,73933.01,73933.01,73933.01,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,9640.68,9640.68,9640.68,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,2401.14,2401.14,2401.14,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,18863.58,18863.58,18863.58,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,9617.46,9617.46,9617.46,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,42078.27,42078.27,42078.27,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,11395.9,11395.9,23370.81,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,9446.33,9446.33,9586.59,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,520.22,520.22,520.22,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,12360.78,12360.78,12360.78,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,31478.61,31478.61,31478.61,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12481.96,12481.96,12481.96,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3282.53,3282.53,3282.53,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,10290.35,10290.35,10290.35,1 through 10,percent of total billed charges,,,
Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23943.81,23943.81,23943.81,1 through 10,percent of total billed charges,,,
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,23564.24,23564.24,23564.24,1 through 10,percent of total billed charges,,,
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,24835.73,24835.73,24835.73,1 through 10,percent of total billed charges,,,
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,45064.73,45064.73,45064.73,1 through 10,percent of total billed charges,,,
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6299.83,6299.83,6299.83,1 through 10,percent of total billed charges,,,
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,2910.77,2910.77,2910.77,1 through 10,percent of total billed charges,,,
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,17844.42,17844.42,17844.42,1 through 10,percent of total billed charges,,,
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,40811.28,12233.24,77658.38,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,47491.46,27048.25,114224.64,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,15457.22,15457.22,32303.32,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,84923.92,84923.92,84923.92,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,25704.93,25704.93,25704.93,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10250.71,10250.71,10250.71,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,13025.11,11645.77,41655.83,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,128478.71,128478.71,128478.71,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,39698.64,30963.66,115096.39,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10391.79,10391.79,10391.79,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11666.61,11666.61,11666.61,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,26921.16,26921.16,26921.16,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5894.76,5894.76,5894.76,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,16980.36,16980.36,16980.36,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,18061.02,18061.02,18061.02,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6879.44,6879.44,6879.44,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,34678.32,34678.32,34678.32,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,20220.36,20220.36,22563.28,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4887.97,4887.97,4887.97,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,50235.87,50235.87,50235.87,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,20461.02,20461.02,20461.02,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,8992.16,8992.16,8992.16,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,57884.47,57884.47,57884.47,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15878.94,15878.94,15878.94,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,19096.9,19096.9,19096.9,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,44250.74,44250.74,44250.74,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19592.6,19592.6,19592.6,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7657.42,7657.42,7657.42,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,16215.87,16215.87,16215.87,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,32013.55,32013.55,32013.55,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,6248.27,6248.27,6248.27,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,3350.55,3350.55,3350.55,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,4011.37,4011.37,4011.37,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,11615.28,11615.28,11615.28,1 through 10,percent of total billed charges,,,
Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5132.06,5132.06,5132.06,1 through 10,percent of total billed charges,,,
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,57259.96,57259.96,57259.96,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23584.13,19985.51,52625.59,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,51009.64,51009.64,51009.64,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,25201.09,25201.09,25201.09,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,49915.23,49915.23,49915.23,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,43681.56,40448.72,45444.95,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4389.72,4389.72,4389.72,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,34631.44,34631.44,34631.44,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,9230.5,9230.5,9230.5,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,37499.03,26187.81,49329.96,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,20969.34,20969.34,20969.34,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,44382.95,44382.95,44382.95,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16146.01,16146.01,20023.81,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,12869.56,12869.56,23930.88,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,20738.81,20738.81,20738.81,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25904.07,25420.42,30364.19,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,23139.98,23139.98,23139.98,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23192.26,23192.26,23192.26,1 through 10,percent of total billed charges,,,
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,86842.71,86842.71,86842.71,1 through 10,percent of total billed charges,,,
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,49858.53,49858.53,49858.53,1 through 10,percent of total billed charges,,,
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,22506.5,22506.5,22506.5,1 through 10,percent of total billed charges,,,
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,60089.37,60089.37,60089.37,1 through 10,percent of total billed charges,,,
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17696.17,17696.17,17696.17,1 through 10,percent of total billed charges,,,
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16791.62,16791.62,16791.62,1 through 10,percent of total billed charges,,,
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,59876.92,59876.92,59876.92,1 through 10,percent of total billed charges,,,
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,51872.36,51872.36,51872.36,1 through 10,percent of total billed charges,,,
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,52051.61,52051.61,52051.61,1 through 10,percent of total billed charges,,,
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7102.46,7102.46,7102.46,1 through 10,percent of total billed charges,,,
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,98735.28,98735.28,424058.55,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,24148.78,24148.78,24148.78,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,6180.11,6180.11,6180.11,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,52758.65,52758.65,52758.65,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4891.95,4891.95,4891.95,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,15258.08,15258.08,15258.08,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12836.51,12836.51,13805.12,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,27739.89,27739.89,27739.89,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,85145.2,85145.2,85145.2,1 through 10,percent of total billed charges,,,
Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,11136.44,8736.35,19536.77,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,32584.91,32584.91,32584.91,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,12175.31,5705.07,36111.12,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,21924.98,21924.98,21924.98,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1557,1557,1557,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,8276.18,8276.18,8276.18,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,9875.35,7260.33,15003.3,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,42246.4,42246.4,42246.4,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10955.53,7479.91,20285.6,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1878.66,1878.66,1878.66,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,11224.61,11224.61,23308.6,1 through 10,percent of total billed charges,,,
Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,18406.9,18406.9,18406.9,1 through 10,percent of total billed charges,,,
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,3730.59,3730.59,3730.59,1 through 10,percent of total billed charges,,,
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,11449.63,11449.63,11449.63,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5217,5217,5855.18,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,13598.15,9438.95,20032.27,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,13578.05,13578.05,13578.05,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,9777.46,9777.46,9777.46,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5233.18,5233.18,5233.18,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,4247.51,4247.51,5875.18,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28216.98,28216.98,28216.98,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6921.76,6921.76,6921.76,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,5488.41,5488.41,5488.41,1 through 10,percent of total billed charges,,,
Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,16275.2,16275.2,16275.2,1 through 10,percent of total billed charges,,,
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20935.28,20935.28,20935.28,1 through 10,percent of total billed charges,,,
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,23628.88,23628.88,23628.88,1 through 10,percent of total billed charges,,,
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,52372.74,52372.74,52372.74,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,31426.97,31426.97,31426.97,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19277.13,19277.13,19277.13,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,7522.3,7522.3,7522.3,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,21389.59,21389.59,21389.59,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1584.07,1584.07,1584.07,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6086.57,6086.57,6086.57,1 through 10,percent of total billed charges,,,
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1342.66,1342.66,1342.66,1 through 10,percent of total billed charges,,,
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,11123.49,11123.49,11123.49,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,66798.77,66798.77,66798.77,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,36500.99,36500.99,36500.99,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,6022.67,6022.67,8461.2,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5296.57,5296.57,5296.57,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,5253.75,5253.75,5253.75,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7832.34,5597.07,8286.93,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,11867.06,11867.06,11867.06,1 through 10,percent of total billed charges,,,
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,23877.29,23877.29,23877.29,1 through 10,percent of total billed charges,,,
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,9506.45,9506.45,23134.17,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,8786.74,8786.74,8786.74,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,23190.38,23190.38,23190.38,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,3719.89,3719.89,3719.89,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,18993.33,18993.33,18993.33,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14979.74,14979.74,14979.74,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,7381.75,7381.75,7381.75,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2241.04,2241.04,2241.04,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3960.66,3960.66,3960.66,1 through 10,percent of total billed charges,,,
Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,1828.52,1828.52,1828.52,1 through 10,percent of total billed charges,,,
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,4145.78,4145.78,6757.49,1 through 10,percent of total billed charges,,,
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10249.64,10249.64,10249.64,1 through 10,percent of total billed charges,,,
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11529.47,11529.47,11529.47,1 through 10,percent of total billed charges,,,
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,4329.61,4329.61,7660.01,1 through 10,percent of total billed charges,,,
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,10569.4,10569.4,10569.4,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4926.15,4926.15,4926.15,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,16092.52,16092.52,16092.52,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,8935.95,8935.95,8935.95,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1854.71,1854.71,1854.71,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7502.7,7502.7,7502.7,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3183.25,3183.25,3183.25,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,6715.51,6715.51,6715.51,1 through 10,percent of total billed charges,,,
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,33683.14,33683.14,33683.14,1 through 10,percent of total billed charges,,,
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3054.14,3054.14,3054.14,1 through 10,percent of total billed charges,,,
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,6311.15,6311.15,6311.15,1 through 10,percent of total billed charges,,,
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,125384.24,125384.24,125384.24,1 through 10,percent of total billed charges,,,
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,220551.91,220551.91,220551.91,1 through 10,percent of total billed charges,,,
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,34302.14,34302.14,34302.14,1 through 10,percent of total billed charges,,,
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,139560.66,139560.66,139560.66,1 through 10,percent of total billed charges,,,
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,66278.65,66278.65,66278.65,1 through 10,percent of total billed charges,,,
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,32076.76,32076.76,32076.76,1 through 10,percent of total billed charges,,,
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,41112.46,41112.46,41112.46,1 through 10,percent of total billed charges,,,
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,21596.84,21596.84,21596.84,1 through 10,percent of total billed charges,,,
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,20694.92,20694.92,20694.92,1 through 10,percent of total billed charges,,,
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,41382.79,41382.79,41382.79,1 through 10,percent of total billed charges,,,
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,30076.11,30076.11,30076.11,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,24860.23,22200.73,63622.42,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,14887.72,14887.72,14887.72,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,13276.57,9238.63,18805.36,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,15765.05,8177.06,71993.68,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,15342.17,15342.17,15342.17,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23403.4,22753.44,69956.19,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13274.24,13274.24,13274.24,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,16254.95,9082.73,27297.17,1 through 10,percent of total billed charges,,,
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,5528.82,4994.26,32446.94,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,18155.87,7472.5,24758.68,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10742.29,7538.3,22929,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,18135.63,18135.63,18135.63,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,19825.36,19825.36,19825.36,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,23032.76,23032.76,23032.76,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,11643.5,11643.5,11643.5,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14382.07,14382.07,14382.07,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11332.08,11332.08,11332.08,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,10882.34,10882.34,10882.34,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,30845.74,30845.74,30845.74,1 through 10,percent of total billed charges,,,
Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6475.4,6475.4,6475.4,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19925.09,18442.85,96440.64,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,14177.73,14177.73,14177.73,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23454.72,23454.72,23454.72,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10037.12,10037.12,39050.35,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,36454.74,36454.74,36454.74,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,30861.15,30861.15,44472.36,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,16972.65,16972.65,16972.65,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,22991.21,22991.21,22991.21,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,38853.11,38853.11,57480.44,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,17638.44,17638.44,35319.96,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28161.89,17583.95,88520.71,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,26382.15,26382.15,26382.15,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,14502.31,14502.31,14502.31,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,17669.84,17669.84,45913.12,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6725.44,6725.44,6725.44,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,43060.19,43060.19,43060.19,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,16000.72,16000.72,16000.72,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5867.39,5867.39,5867.39,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,20459.38,20459.38,20459.38,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,12371.22,12371.22,21119,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,14259.41,14259.41,14259.41,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,13139.61,13139.61,26568.78,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,6470,6470,6470,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9822.66,9822.66,15968.77,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8559.87,8559.87,8559.87,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,21151.27,21151.27,21151.27,1 through 10,percent of total billed charges,,,
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,32937.22,32937.22,32937.22,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,31138.71,31138.71,31138.71,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,63324.46,63324.46,97734.43,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17881.25,17881.25,17881.25,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15218.55,15218.55,56455.68,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,21813.84,21421.33,42840.68,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,89616.11,89616.11,89616.11,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,7020.26,7020.26,7020.26,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10316.44,10316.44,10316.44,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9116.74,9116.74,9116.74,1 through 10,percent of total billed charges,,,
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5683.23,5683.23,5683.23,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,14680.47,14680.47,14680.47,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7783.28,7783.28,7783.28,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6214.65,6214.65,17526.41,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,15017.66,15017.66,15017.66,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,11212.69,11212.69,20379.31,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8556.19,8556.19,8556.19,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,24030.09,24030.09,24030.09,1 through 10,percent of total billed charges,,,
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11434.82,11434.82,11434.82,1 through 10,percent of total billed charges,,,
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,23332.32,23332.32,23332.32,1 through 10,percent of total billed charges,,,
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18781.56,18781.56,18781.56,1 through 10,percent of total billed charges,,,
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,14410.88,14410.88,14410.88,1 through 10,percent of total billed charges,,,
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,14808.95,7797.11,21332.51,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,30814.94,30814.94,30814.94,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,16217.55,14887.16,31129.23,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,17685.35,17685.35,17685.35,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,30868.16,30868.16,30868.16,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,14363.66,13774.35,40087.24,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,28516.27,28516.27,28516.27,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,27333.2,18687.93,48670.21,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,17195.26,17195.26,35108.04,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21903.72,16539.75,91322.44,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,27677.9,27677.9,27677.9,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,7261.01,7261.01,12893.14,1 through 10,percent of total billed charges,,,
Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,17703.99,17189.77,51640.37,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,17142.95,11233.03,52124.8,15,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,5975.74,5975.74,5975.74,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7353.64,7353.64,8800.7,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,12089.16,12089.16,12089.16,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,12122.66,12111.34,41145.22,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,6549.58,6549.58,40880.93,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,13638.01,5653.74,17918.64,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,26469.16,26469.16,26469.16,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,15861.72,8488.56,28384.73,11,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,17711.08,10615.54,43001.27,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16220.95,10022.54,21306.27,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,8759.64,8759.64,8759.64,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,6112.93,5103.33,7985.12,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7047.25,3946.18,19714.63,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7080.36,7080.36,8395.84,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,11345.67,11345.67,11345.67,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,11357.46,11357.46,11357.46,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,9774.72,9774.72,9827.53,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,16774.11,16774.11,16774.11,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,17195.88,17195.88,17195.88,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,17663.1,17663.1,17663.1,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,7259.16,7259.16,7259.16,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6887.73,2205.06,21920.24,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13258.85,13258.85,13258.85,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,11280.87,11280.87,11280.87,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,9374.47,9374.47,9374.47,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1140.19,1140.19,1140.19,1 through 10,percent of total billed charges,,,
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,17264.91,17264.91,17264.91,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19557.58,9027.76,22588.44,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,17221.36,17221.36,17221.36,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,6757.46,6757.46,6757.46,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,33107.46,33107.46,33107.46,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,16702.96,16702.96,16702.96,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,10817.14,10817.14,39025.8,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,15535.49,15535.49,15535.49,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17516.8,17516.8,28407.97,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,18817.05,18817.05,22801.64,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,19154.21,8732.03,36759.94,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,26286.48,26286.48,26286.48,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,21882.81,21882.81,29108.27,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,18825.09,9924.12,33349.92,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,23491.22,23491.22,23491.22,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11105.17,11105.17,11105.17,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8635.89,8635.89,8635.89,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,9655.73,9655.73,9655.73,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,6326.12,6326.12,6326.12,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,8289.01,8289.01,8289.01,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,9816.33,9816.33,9816.33,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,20260.71,20260.71,20260.71,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4739.96,4739.96,13167.41,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,8732.56,8732.56,16987.89,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11424.23,5560.26,19448.86,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,14782.29,14782.29,14782.29,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5518.95,4894.95,10729.92,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6748.36,6748.36,6748.36,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6651.64,6651.64,6651.64,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,5449.86,5449.86,5449.86,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,17121.95,17121.95,17121.95,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,4358.93,4358.93,4358.93,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5304.23,4761.84,7625.51,1 through 10,percent of total billed charges,,,
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,7832.54,7832.54,7832.54,1 through 10,percent of total billed charges,,,
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,83821.58,83821.58,83821.58,1 through 10,percent of total billed charges,,,
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,53939.17,53939.17,53939.17,1 through 10,percent of total billed charges,,,
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,27239.62,27239.62,27239.62,1 through 10,percent of total billed charges,,,
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1919.22,1919.22,1919.22,1 through 10,percent of total billed charges,,,
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10950.78,10950.78,10950.78,1 through 10,percent of total billed charges,,,
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14635.01,14635.01,14635.01,1 through 10,percent of total billed charges,,,
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,20026.69,20026.69,20026.69,1 through 10,percent of total billed charges,,,
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,22171.15,22171.15,22171.15,1 through 10,percent of total billed charges,,,
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,13812.32,13812.32,13812.32,1 through 10,percent of total billed charges,,,
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,13851.31,13851.31,13851.31,1 through 10,percent of total billed charges,,,
Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,45018.62,45018.62,45018.62,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,11080.77,11080.77,11080.77,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9832.69,9832.69,9832.69,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,33692.64,33692.64,33692.64,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,21608.75,21608.75,21608.75,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,17058.9,17058.9,17058.9,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,4907.83,4907.83,4907.83,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,25931.32,25931.32,25931.32,1 through 10,percent of total billed charges,,,
Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6788.39,6788.39,6788.39,1 through 10,percent of total billed charges,,,
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4370.16,4370.16,4370.16,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,9247.06,9247.06,9247.06,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13262.1,13262.1,13402.89,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,9594.28,9594.28,9594.28,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,24654.37,24654.37,24654.37,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,11635.48,11635.48,11635.48,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,17026.27,17026.27,17026.27,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,35019.28,14535.19,51602.23,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,19518.89,19518.89,19518.89,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6638.95,5746.28,31046.72,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1578.3,1578.3,1578.3,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1172.85,1172.85,1172.85,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7107.04,5307.97,28562.62,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,5510.72,5510.72,5510.72,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5184.09,3069.45,8946.98,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3812.4,3812.4,3812.4,1 through 10,percent of total billed charges,,,
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,15534.57,15534.57,15534.57,1 through 10,percent of total billed charges,,,
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10962.23,10962.23,10962.23,1 through 10,percent of total billed charges,,,
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,35740.98,35740.98,35740.98,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4477,4477,4477,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,15858.2,15858.2,15858.2,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13433.56,13433.56,13433.56,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,8818.98,8818.98,8818.98,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,9523.17,9523.17,9523.17,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,8825.1,8825.1,8825.1,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7872.72,7872.72,11909.32,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,20345.74,20345.74,20345.74,1 through 10,percent of total billed charges,,,
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,223120.65,223120.65,223120.65,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,36755.94,36755.94,36755.94,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,79867.93,79867.93,79867.93,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,34532.4,34532.4,34532.4,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,80670.16,59199.83,123479.57,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,155786.61,155786.61,155786.61,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,32394.08,32394.08,32394.08,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,36424.01,36424.01,36424.01,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,51322.83,51322.83,78489.28,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,20731.74,20731.74,20731.74,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,24913.27,24913.27,24913.27,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,25626.46,25626.46,25626.46,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,28328.62,28328.62,28328.62,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,28191.75,28191.75,28191.75,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,44761.12,44761.12,44761.12,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,6165.07,6165.07,6165.07,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20091.22,20091.22,91562.77,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,35829.87,35829.87,35829.87,1 through 10,percent of total billed charges,,,
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,61185.64,61185.64,61185.64,1 through 10,percent of total billed charges,,,
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,13218.37,13218.37,13218.37,1 through 10,percent of total billed charges,,,
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,105404.62,105404.62,105404.62,1 through 10,percent of total billed charges,,,
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,25075.86,25075.86,25075.86,1 through 10,percent of total billed charges,,,
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,72420.36,72420.36,72420.36,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,46306.22,46306.22,46306.22,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,60151.96,60151.96,60151.96,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,83711.53,83711.53,83711.53,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,22562.9,22562.9,22562.9,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,61281.8,61281.8,61281.8,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,14997.24,14997.24,14997.24,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,34943.29,34943.29,34943.29,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,17591.92,17591.92,17591.92,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,12577.7,12577.7,12577.7,1 through 10,percent of total billed charges,,,
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,41377.17,41377.17,41377.17,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,89071.89,89071.89,89071.89,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,40328.53,40328.53,40328.53,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,84732.24,84732.24,84732.24,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,53859.8,53859.8,53859.8,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,13459.66,13459.66,13459.66,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,53338.35,53338.35,53338.35,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,32937.48,32937.48,32937.48,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,75554.97,75554.97,75554.97,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,37796.94,37796.94,37796.94,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,39096.22,39096.22,39096.22,1 through 10,percent of total billed charges,,,
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,31227.84,31227.84,31227.84,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,43847.13,43847.13,43847.13,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9026.46,9026.46,9026.46,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,31172.92,31172.92,31172.92,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,82257.49,82257.49,82257.49,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,53438.37,53438.37,53438.37,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,67108.68,53746.12,121091.07,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,54279.47,54279.47,54279.47,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,76922.27,76922.27,76922.27,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,61776.33,61776.33,61776.33,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,30206.56,30206.56,30206.56,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,30588.26,30588.26,30588.26,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,45849.19,45849.19,58842.87,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,33061.12,33061.12,33061.12,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,23198.99,23198.99,23198.99,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,80521.89,80521.89,90370.42,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19015.34,19015.34,28419.14,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,20725.17,20725.17,20725.17,1 through 10,percent of total billed charges,,,
Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,41238.06,41238.06,45696.55,1 through 10,percent of total billed charges,,,
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,15655.27,15655.27,15655.27,1 through 10,percent of total billed charges,,,
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,30839.23,30839.23,30839.23,1 through 10,percent of total billed charges,,,
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19667.2,19667.2,19667.2,1 through 10,percent of total billed charges,,,
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,33173.35,33173.35,33173.35,1 through 10,percent of total billed charges,,,
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19577.77,19577.77,31778.69,1 through 10,percent of total billed charges,,,
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,8748.09,8748.09,8748.09,1 through 10,percent of total billed charges,,,
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,28475.23,28475.23,28475.23,1 through 10,percent of total billed charges,,,
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,92045.73,92045.73,92045.73,1 through 10,percent of total billed charges,,,
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,148044.69,148044.69,148044.69,1 through 10,percent of total billed charges,,,
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,39866.46,39866.46,39866.46,1 through 10,percent of total billed charges,,,
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,38874.9,38874.9,38874.9,1 through 10,percent of total billed charges,,,
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,7509.51,7509.51,7509.51,1 through 10,percent of total billed charges,,,
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,46828.43,46828.43,60756.76,1 through 10,percent of total billed charges,,,
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,120953.44,120953.44,120953.44,1 through 10,percent of total billed charges,,,
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,37949.99,37949.99,37949.99,1 through 10,percent of total billed charges,,,
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,54368.95,54368.95,54368.95,1 through 10,percent of total billed charges,,,
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,41694.37,41694.37,41694.37,1 through 10,percent of total billed charges,,,
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,66195.46,66195.46,66195.46,1 through 10,percent of total billed charges,,,
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,67043.08,67043.08,67043.08,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,37999.03,37999.03,37999.03,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,62664.77,62664.77,62664.77,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18875.49,18875.49,18875.49,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,62232.26,62232.26,62232.26,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,25251.2,25251.2,25251.2,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,23322.13,23322.13,23322.13,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,49026.93,49026.93,49026.93,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,42869.55,42869.55,42869.55,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,26977.54,26977.54,26977.54,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28194.48,28194.48,28194.48,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,35895.6,35895.6,35895.6,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,33160.76,33160.76,33160.76,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15887.34,15887.34,15887.34,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,20465.11,20465.11,20465.11,1 through 10,percent of total billed charges,,,
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,86860.37,86860.37,86860.37,1 through 10,percent of total billed charges,,,
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,48143.27,48143.27,48143.27,1 through 10,percent of total billed charges,,,
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,146284.24,146284.24,146284.24,1 through 10,percent of total billed charges,,,
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,138105.19,138105.19,138105.19,1 through 10,percent of total billed charges,,,
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,112622.51,112622.51,112622.51,1 through 10,percent of total billed charges,,,
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,76228.07,76228.07,76228.07,1 through 10,percent of total billed charges,,,
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,210276.97,210276.97,210276.97,1 through 10,percent of total billed charges,,,
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,81107.89,81107.89,81107.89,1 through 10,percent of total billed charges,,,
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,24789.11,11713.37,58159.58,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,21867.35,7296.85,33800.19,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25825.16,10577.86,53161.02,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,7500.51,6131.69,28591.11,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,23405.25,23405.25,26972.88,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,28465.24,28465.24,30139.06,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,15848.17,15022.75,50475.91,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,29398.98,6848.25,59379.68,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,21412.79,21412.79,21412.79,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,20365.15,12693.43,79786.33,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,23422.75,15706.38,30613.77,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,32414.56,32414.56,42983.82,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,38290.6,33359.34,40905.62,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,12589.77,12589.77,12589.77,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,30428.23,5371.71,76907.15,11,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8796,7831.25,33695.24,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19979.27,19979.27,19979.27,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,21317.72,21317.72,21317.72,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,20034.04,20009.22,66140.36,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,18793.63,18478.5,27811.94,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7143.16,5442.18,31041.1,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3479.61,3479.61,3479.61,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3512.53,1086.43,58894.01,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10036.65,10036.65,14067.43,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4969.15,4969.15,4969.15,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,10154.74,10154.74,10154.74,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10009.99,10009.99,10009.99,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,562.02,562.02,562.02,1 through 10,percent of total billed charges,,,
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,78474.92,78474.92,78474.92,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,48980.85,48980.85,48980.85,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,46668.32,46668.32,46668.32,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,33805.26,17507.26,46045.89,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,40731.18,40731.18,40731.18,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,106854.61,106854.61,106854.61,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,30804.47,30804.47,30804.47,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19996.56,19996.56,20846.04,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8854.52,8854.52,8854.52,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,17080.65,17080.65,17080.65,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,12442.88,12442.88,12442.88,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,33024.09,33024.09,33024.09,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11600.6,11600.6,11600.6,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,11440.66,11440.66,20402.84,1 through 10,percent of total billed charges,,,
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22768.33,22768.33,22768.33,1 through 10,percent of total billed charges,,,
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,21083.94,8892.23,81303.46,18,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,48713.7,48713.7,58615.17,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14789.62,9720.71,20203.04,12,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,12974.42,8561.52,18300.34,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,17698.34,17698.34,17698.34,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,37833.28,37833.28,37833.28,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,46965.37,46965.37,46965.37,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,17582.13,12925.53,50855.51,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,41235.62,41235.62,41235.62,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,12538.06,9534.34,19542.11,12,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,34803.6,10379.68,72408.89,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18353.61,9988.87,29132.95,14,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11782.5,11782.5,11782.5,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,13060.42,1172.85,21478.97,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,10847.53,6112.86,25370.03,16,percent of total billed charges,,,
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4447.16,4447.16,4447.16,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,30806.31,30806.31,30806.31,1 through 10,percent of total billed charges,,,
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,9535.84,9535.84,9535.84,1 through 10,percent of total billed charges,,,
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25857.77,25857.77,25857.77,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,12158.96,12158.96,21453.43,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,11431.74,11431.74,11431.74,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17424.98,17424.98,17424.98,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,14241.31,14241.31,14241.31,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,25742.47,25742.47,25742.47,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,30913.16,30913.16,30913.16,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,40280.16,40280.16,40280.16,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6449.34,6449.34,6449.34,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11503.72,11503.72,11503.72,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,16459.44,16459.44,16459.44,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,27790.37,27790.37,27790.37,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,16452.28,16452.28,16452.28,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,2411.98,2411.98,2411.98,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,22357.7,22357.7,22357.7,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9135.14,5376.74,23415.98,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3970,3970,3970,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,46701.27,46701.27,46701.27,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,3515.05,3515.05,3515.05,1 through 10,percent of total billed charges,,,
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,11815.4,11815.4,18276.23,1 through 10,percent of total billed charges,,,
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17142.49,17142.49,17142.49,1 through 10,percent of total billed charges,,,
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,6764.69,6764.69,6764.69,1 through 10,percent of total billed charges,,,
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5855.01,5855.01,5855.01,1 through 10,percent of total billed charges,,,
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,10139.38,10139.38,10139.38,1 through 10,percent of total billed charges,,,
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5545.2,5545.2,5545.2,1 through 10,percent of total billed charges,,,
Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,56903.02,56903.02,56903.02,1 through 10,percent of total billed charges,,,
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,21545.94,21545.94,21545.94,1 through 10,percent of total billed charges,,,
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,25728.47,25728.47,25728.47,1 through 10,percent of total billed charges,,,
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9129.71,9129.71,9129.71,1 through 10,percent of total billed charges,,,
Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,21840.68,21840.68,21840.68,1 through 10,percent of total billed charges,,,
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,7270.17,7270.17,7270.17,1 through 10,percent of total billed charges,,,
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,13659.27,13659.27,13659.27,1 through 10,percent of total billed charges,,,
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,1114.47,1114.47,1114.47,1 through 10,percent of total billed charges,,,
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,35276.2,35276.2,35276.2,1 through 10,percent of total billed charges,,,
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,9994.01,9994.01,9994.01,1 through 10,percent of total billed charges,,,
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,5237.03,5237.03,5237.03,1 through 10,percent of total billed charges,,,
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,13507.92,13507.92,13507.92,1 through 10,percent of total billed charges,,,
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5047.34,5047.34,5047.34,1 through 10,percent of total billed charges,,,
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,34613.4,34613.4,34613.4,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,33198.81,19326.24,33936.92,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,8893.97,8893.97,8893.97,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10195.31,10195.31,10195.31,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,35198.69,20498.71,41690.98,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,10512.71,10512.71,10512.71,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,18543.22,13071.9,25436.12,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9651.39,9651.39,9651.39,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7425.89,7425.89,19243.65,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,8942.31,8942.31,8942.31,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,8552.34,8552.34,8552.34,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,7617.21,7617.21,23040.6,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,9685.48,4814.47,13567.88,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,10317.09,10317.09,10317.09,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11505.97,11505.97,16052.22,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2777.01,2777.01,2777.01,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7312.52,5197.52,30021.01,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,4498.38,4498.38,4498.38,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7730.94,7730.94,14239.68,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,6101.28,6101.28,8785.38,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,4121.85,4121.85,4121.85,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,5902.69,5902.69,5902.69,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5302.02,5302.02,5302.02,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,15737.38,15737.38,15737.38,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,8495.3,8495.3,8495.3,1 through 10,percent of total billed charges,,,
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3665.52,3665.52,3665.52,1 through 10,percent of total billed charges,,,
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,7182.1,7182.1,7182.1,1 through 10,percent of total billed charges,,,
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8229.46,8229.46,8229.46,1 through 10,percent of total billed charges,,,
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10801.23,714.4,20690.66,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,16031.92,16031.92,16031.92,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11791.29,5329.52,18001.88,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10866.75,10582.88,12822.39,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,9964.2,9684.63,14509.55,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,14754.53,14754.53,14754.53,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,29344.62,29344.62,29344.62,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,29785.9,29785.9,29785.9,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,8957.9,8957.9,8957.9,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,13614.76,13614.76,13614.76,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10724.25,10724.25,13350.78,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,23974.47,17101.18,25209.66,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6584.03,5806.72,18063.41,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,4074,4074,4074,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11627.5,11627.5,11627.5,1 through 10,percent of total billed charges,,,
Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8086.5,2606.57,24824.58,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,3261.6,3261.6,6345.68,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5861.87,5861.87,5861.87,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,4416.38,4416.38,4416.38,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,3907.95,3907.95,3907.95,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9854.76,9854.76,9854.76,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,12632.48,12632.48,12632.48,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6251.21,6251.21,7332.1,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,12447.72,12447.72,12447.72,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6716.14,6716.14,6716.14,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3076.65,687.87,10149.32,1 through 10,percent of total billed charges,,,
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,23915.31,23915.31,23915.31,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,25833.2,25833.2,25833.2,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,22690.87,22690.87,22690.87,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,49144.54,49144.54,49144.54,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,44965.15,44965.15,44965.15,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25095.51,25095.51,25095.51,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,20091.92,20091.92,20091.92,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,101038.62,101038.62,101038.62,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,14177.09,14177.09,14177.09,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20027.48,13380.59,24538.09,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1609.19,1609.19,1609.19,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,67839.47,67839.47,67839.47,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8778.39,8778.39,8778.39,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17250.89,17250.89,17250.89,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9337.96,9337.96,9337.96,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,19584.45,19584.45,42679.64,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,9866.1,9866.1,9866.1,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8851.02,8851.02,8851.02,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3775.27,3775.27,3775.27,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3863.95,3863.95,3863.95,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,24431.25,24431.25,24431.25,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7651.23,7651.23,7651.23,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1682.4,1682.4,1682.4,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,742.96,742.96,742.96,1 through 10,percent of total billed charges,,,
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,41314.57,41314.57,41314.57,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,52912.82,52912.82,52912.82,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,58435.87,58435.87,58435.87,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,51927.17,51927.17,51927.17,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,47418.48,47418.48,47418.48,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,74601.58,74601.58,74601.58,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,35492.88,35492.88,35492.88,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,63013.11,63013.11,63013.11,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,40705.23,40705.23,40705.23,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,28988.19,28988.19,43841.25,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,43309.41,43309.41,43309.41,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,20172.32,20172.32,20172.32,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,48866.12,48866.12,48866.12,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,26684.87,22734.92,42980.77,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,60244.45,60244.45,60244.45,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,32312.39,32312.39,32312.39,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,20090.81,20090.81,28020.47,1 through 10,percent of total billed charges,,,
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,42533.76,42533.76,42533.76,1 through 10,percent of total billed charges,,,
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,41216.71,41216.71,41216.71,1 through 10,percent of total billed charges,,,
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,282661.02,282661.02,282661.02,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,327534.04,327534.04,327534.04,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,2832.87,2832.87,2832.87,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,48716.1,48716.1,48716.1,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,37852.25,29148,49113.06,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23358.75,23358.75,23358.75,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,53545.6,53545.6,53545.6,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,27027.73,27027.73,27027.73,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,23069.55,23069.55,23069.55,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,17687.86,17687.86,17687.86,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,36278.3,36278.3,36278.3,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,26798.35,16146.42,35256.14,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,33513.1,33513.1,33513.1,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,33130.41,33130.41,33130.41,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,30861.86,30861.86,30861.86,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28510.86,28510.86,28510.86,1 through 10,percent of total billed charges,,,
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,69863.71,69863.71,69863.71,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,39393.11,39393.11,39393.11,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,120160.65,120160.65,120160.65,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,41081.49,41081.49,41081.49,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,254282.35,254282.35,254282.35,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24023.32,24023.32,24023.32,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,197713.5,197713.5,197713.5,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,24759.37,24759.37,24759.37,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,39988.19,20425.71,60274.76,11,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,36040.61,28118.86,48550.87,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,31464.8,31464.8,31464.8,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,81001.49,81001.49,81001.49,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,32263.83,32263.83,36652.64,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,50230.75,50230.75,50230.75,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,52398.21,52398.21,52398.21,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,31130.83,31130.83,31130.83,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,26658.38,26658.38,26658.38,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,16305.11,16305.11,16305.11,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27268.7,20774.87,51076.65,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,28920.31,28920.31,35782.81,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,21771.82,21771.82,21771.82,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,33497.98,33497.98,33497.98,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29799.39,29799.39,29799.39,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,31537.93,31537.93,31537.93,1 through 10,percent of total billed charges,,,
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,52575.49,52575.49,52575.49,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,41001,41001,41001,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,30601.78,30601.78,36357.93,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,52705.21,52705.21,52705.21,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,26703.53,26703.53,26703.53,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,45803.89,45803.89,45803.89,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,15793.82,15793.82,15793.82,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,21996.17,21996.17,21996.17,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,34288.44,34288.44,34288.44,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,73158.66,73158.66,73158.66,1 through 10,percent of total billed charges,,,
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,21334.23,21334.23,21334.23,1 through 10,percent of total billed charges,,,
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,38080,38080,38080,1 through 10,percent of total billed charges,,,
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,32384.45,32384.45,32384.45,1 through 10,percent of total billed charges,,,
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,408.64,408.64,408.64,1 through 10,percent of total billed charges,,,
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,12965.45,12965.45,12965.45,1 through 10,percent of total billed charges,,,
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,11260.59,11260.59,11260.59,1 through 10,percent of total billed charges,,,
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18159.87,18159.87,18159.87,1 through 10,percent of total billed charges,,,
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,26070.26,26070.26,26070.26,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,50754.69,50754.69,50754.69,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,36562.94,36562.94,36562.94,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28108.52,28108.52,41342.14,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,26635.18,26635.18,26635.18,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,34083.08,34083.08,34083.08,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3571.27,3571.27,3571.27,1 through 10,percent of total billed charges,,,
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,81955.66,81955.66,81955.66,1 through 10,percent of total billed charges,,,
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,30344.76,30344.76,30344.76,1 through 10,percent of total billed charges,,,
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,37787.95,37787.95,37787.95,1 through 10,percent of total billed charges,,,
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,63768.49,63768.49,63768.49,1 through 10,percent of total billed charges,,,
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19886.93,19886.93,19886.93,1 through 10,percent of total billed charges,,,
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,25226.07,25226.07,25226.07,1 through 10,percent of total billed charges,,,
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23374.69,23374.69,23374.69,1 through 10,percent of total billed charges,,,
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13865.86,13865.86,13865.86,1 through 10,percent of total billed charges,,,
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14249.96,14249.96,14249.96,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17251.09,17251.09,26157.75,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22574.61,22574.61,22574.61,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,13210.19,13210.19,13210.19,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8908.28,8908.28,8908.28,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,9750.22,9750.22,9750.22,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8158.29,5102.87,14656.87,1 through 10,percent of total billed charges,,,
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,25259.75,25259.75,25259.75,1 through 10,percent of total billed charges,,,
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,3571.21,3571.21,3571.21,1 through 10,percent of total billed charges,,,
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,18592.19,18592.19,18592.19,1 through 10,percent of total billed charges,,,
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,60416.06,60416.06,60416.06,1 through 10,percent of total billed charges,,,
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,15184.48,15184.48,15184.48,1 through 10,percent of total billed charges,,,
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29989.66,29989.66,29989.66,1 through 10,percent of total billed charges,,,
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4993.95,4993.95,37705.53,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15664.95,15664.95,15664.95,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,15765.16,15765.16,15765.16,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,101881.6,101881.6,101881.6,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13651.76,13651.76,25077.5,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,102108.51,102108.51,102108.51,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23741.29,23741.29,23741.29,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,12721.61,12721.61,12721.61,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,50166.48,50166.48,50166.48,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,14812.03,14274.55,23508.78,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,12645.16,12645.16,12645.16,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6324.55,6324.55,6324.55,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10303.07,10303.07,10303.07,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,19986.07,19986.07,19986.07,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,20344.21,20344.21,20344.21,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,4606.28,4606.28,4606.28,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,9540.13,9540.13,9540.13,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,13733.86,13733.86,27588.65,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,26124.88,26124.88,26124.88,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,11139.9,11139.9,11139.9,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,6876.37,6773.71,11441.94,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10083.41,10083.41,10083.41,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,9004.97,9004.97,9004.97,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1810.51,1810.51,1810.51,1 through 10,percent of total billed charges,,,
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12971.28,12971.28,17640.4,1 through 10,percent of total billed charges,,,
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,10449.05,10449.05,10449.05,1 through 10,percent of total billed charges,,,
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,34136.17,34136.17,34136.17,1 through 10,percent of total billed charges,,,
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,22156.14,22156.14,22156.14,1 through 10,percent of total billed charges,,,
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,647.62,647.62,647.62,1 through 10,percent of total billed charges,,,
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,7052.64,7052.64,7052.64,1 through 10,percent of total billed charges,,,
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,81723.22,81723.22,81723.22,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,65815.95,65815.95,65815.95,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21616.57,21616.57,21616.57,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,10195.23,10195.23,10195.23,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16693.7,16693.7,16693.7,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,19834.24,19834.24,19834.24,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,12729.91,12729.91,12729.91,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,10026.28,10026.28,10026.28,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23933.27,23933.27,23933.27,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10689.88,10689.88,10689.88,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,11220.89,11220.89,11220.89,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7962.1,7962.1,7962.1,1 through 10,percent of total billed charges,,,
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,5119.18,5119.18,5119.18,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,12538.06,12538.06,12538.06,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,9568.78,9568.78,9568.78,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8722.68,8722.68,9310.35,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5933.87,5933.87,5933.87,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,4488.05,4488.05,4488.05,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,10645.36,10645.36,10645.36,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,4750.47,4750.47,4750.47,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5829.87,5829.87,5829.87,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5649.49,5649.49,5649.49,1 through 10,percent of total billed charges,,,
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7337.69,7337.69,7337.69,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,14689.35,14689.35,14689.35,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,8087.66,8087.66,8087.66,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,16444.28,16444.28,16444.28,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,14347.69,14347.69,14347.69,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,24465.15,24465.15,27626.94,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11509.08,7514.42,26145.53,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,30237.61,30237.61,30237.61,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,5504.36,5504.36,5504.36,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4684.21,3072.96,11446.23,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6030.07,6030.07,16995.38,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,11580.57,11580.57,11580.57,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,12714.41,4887.23,31298.64,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7548.87,6176.29,19049.92,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,7924.39,7924.39,15481.54,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,6069.53,6069.53,6069.53,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,4705.36,4705.36,4705.36,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6843.19,6843.19,7392.34,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8197.75,2479.84,18437.37,22,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,27733.19,27733.19,27733.19,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2391.96,2391.96,2391.96,1 through 10,percent of total billed charges,,,
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4181.62,1140.35,10032.94,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,13328.19,13328.19,13328.19,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,28434.72,28434.72,28434.72,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,26827.05,26827.05,26827.05,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,20891.73,20891.73,20891.73,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19479.29,19479.29,19479.29,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11944.26,8986.04,12380.23,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13159.92,13159.92,13159.92,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,426.6,426.6,426.6,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2088.96,2088.96,2088.96,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9543.12,9543.12,9543.12,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,29965.32,29965.32,29965.32,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5385.76,5385.76,5385.76,1 through 10,percent of total billed charges,,,
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,21014.81,21014.81,21014.81,1 through 10,percent of total billed charges,,,
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21218.37,21218.37,21218.37,1 through 10,percent of total billed charges,,,
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12047.6,12047.6,12047.6,1 through 10,percent of total billed charges,,,
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15534.78,14326.6,16901.6,1 through 10,percent of total billed charges,,,
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,41964.79,41964.79,41964.79,1 through 10,percent of total billed charges,,,
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1141.37,1141.37,1141.37,1 through 10,percent of total billed charges,,,
Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,51903.35,51903.35,51903.35,1 through 10,percent of total billed charges,,,
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,69073.32,69073.32,69073.32,1 through 10,percent of total billed charges,,,
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,28779.68,28779.68,28779.68,1 through 10,percent of total billed charges,,,
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,53119.24,53119.24,53119.24,1 through 10,percent of total billed charges,,,
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15917.03,15917.03,15917.03,1 through 10,percent of total billed charges,,,
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,26538.8,26538.8,26538.8,1 through 10,percent of total billed charges,,,
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,32219.95,32219.95,32219.95,1 through 10,percent of total billed charges,,,
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,28655.95,28655.95,28655.95,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,44324.72,44324.72,44324.72,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,45464.16,45464.16,45464.16,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,33803.61,33803.61,33803.61,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,32096.34,32096.34,32096.34,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,31568,31568,35050.16,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,39447.61,39447.61,39447.61,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,46659.27,46659.27,46659.27,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,15291.32,15291.32,15291.32,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,28412.64,22647.03,52797.46,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,24650.42,24650.42,24650.42,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,53224.36,53224.36,53224.36,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,28367.7,28367.7,28367.7,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,18137.74,18137.74,18137.74,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29787.3,29787.3,29787.3,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,39335.74,31211.83,44735.89,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,20256.87,20256.87,20256.87,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14631.72,14631.72,14631.72,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,18179.32,18179.32,18179.32,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,26430.71,26430.71,26430.71,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18380.34,15390.23,33584.1,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,16013.28,16013.28,16013.28,1 through 10,percent of total billed charges,,,
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14607.88,14607.88,14607.88,1 through 10,percent of total billed charges,,,
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,64502.28,64502.28,64502.28,1 through 10,percent of total billed charges,,,
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,219870.72,219870.72,219870.72,1 through 10,percent of total billed charges,,,
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,21739.14,21739.14,21739.14,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,26009.66,26009.66,73185.68,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,59794.46,59794.46,59794.46,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,7017.58,7017.58,7017.58,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7911.06,7911.06,7911.06,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23497.17,23497.17,199089.67,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,4218.16,4218.16,4218.16,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15892.36,15892.36,15892.36,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13170.81,13170.81,13170.81,1 through 10,percent of total billed charges,,,
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,18106.91,18106.91,18106.91,1 through 10,percent of total billed charges,,,
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,22808.54,22808.54,22808.54,1 through 10,percent of total billed charges,,,
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,14255.05,14255.05,14255.05,1 through 10,percent of total billed charges,,,
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1409.2,1409.2,1409.2,1 through 10,percent of total billed charges,,,
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,59451.18,59451.18,59451.18,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,13367.06,13367.06,13367.06,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,17313.52,17313.52,17313.52,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,19696.8,19696.8,19696.8,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,13466.68,13466.68,13466.68,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,26477.41,26477.41,26477.41,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10246.51,10246.51,32116.67,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11692.35,11692.35,27315.2,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,7559.88,7559.88,7559.88,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8053.02,6019.9,14751.95,11,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,50966.86,50966.86,50966.86,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,14569.92,14569.92,14569.92,1 through 10,percent of total billed charges,,,
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10067.97,10067.97,10067.97,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,30578.27,30578.27,30578.27,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,68386.19,68386.19,68386.19,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,36415.52,36415.52,36415.52,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,37475.8,37475.8,37475.8,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,13868.13,13868.13,13868.13,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,13165.38,13165.38,13165.38,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,10262.83,10262.83,10262.83,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,11880.03,11880.03,11880.03,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,4228.27,4228.27,4228.27,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10866.1,4405.2,22043.36,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,11270.04,11270.04,11270.04,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,18902.13,18902.13,18902.13,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,15466.42,15466.42,15466.42,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9155.25,9155.25,9155.25,1 through 10,percent of total billed charges,,,
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,18198.39,18198.39,18198.39,1 through 10,percent of total billed charges,,,
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,16343.46,16343.46,16343.46,1 through 10,percent of total billed charges,,,
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22810.78,22810.78,22810.78,1 through 10,percent of total billed charges,,,
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13161.3,13161.3,13161.3,1 through 10,percent of total billed charges,,,
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9718.56,9718.56,9718.56,1 through 10,percent of total billed charges,,,
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,3919.56,3919.56,3919.56,1 through 10,percent of total billed charges,,,
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,144913.45,144913.45,144913.45,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,162945.58,162945.58,162945.58,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,81125.28,81125.28,88336.55,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,109955.05,109955.05,109955.05,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,48795.8,48795.8,48795.8,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,104134.52,104134.52,104134.52,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,65319.07,65319.07,65319.07,1 through 10,percent of total billed charges,,,
Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,179698.09,179698.09,179698.09,1 through 10,percent of total billed charges,,,
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,97570.07,97570.07,97570.07,1 through 10,percent of total billed charges,,,
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,68358.7,68358.7,68358.7,1 through 10,percent of total billed charges,,,
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,51116.61,51116.61,55571.37,1 through 10,percent of total billed charges,,,
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,68712.57,68712.57,68712.57,1 through 10,percent of total billed charges,,,
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,158799.69,158799.69,158799.69,1 through 10,percent of total billed charges,,,
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,95588.62,95588.62,95588.62,1 through 10,percent of total billed charges,,,
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,79755.08,79755.08,79755.08,1 through 10,percent of total billed charges,,,
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,111728.69,111728.69,111728.69,1 through 10,percent of total billed charges,,,
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,129512.7,129512.7,129512.7,1 through 10,percent of total billed charges,,,
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,639654.39,639654.39,639654.39,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,9870.55,9870.55,9870.55,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,108421.21,108421.21,108421.21,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,47827.36,47827.36,47827.36,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,15769.16,15769.16,15769.16,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,57816.16,45235.18,87343.99,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,25776.27,25776.27,25776.27,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,101490.92,101490.92,101490.92,1 through 10,percent of total billed charges,,,
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,115152.96,115152.96,115152.96,1 through 10,percent of total billed charges,,,
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,93417.11,93417.11,93417.11,1 through 10,percent of total billed charges,,,
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,78952.13,78952.13,78952.13,1 through 10,percent of total billed charges,,,
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,106478.09,106478.09,106478.09,1 through 10,percent of total billed charges,,,
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,107236.7,107236.7,107236.7,1 through 10,percent of total billed charges,,,
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,31227.58,31227.58,31227.58,1 through 10,percent of total billed charges,,,
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,23039.03,23039.03,23039.03,1 through 10,percent of total billed charges,,,
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,27242.66,27242.66,27242.66,1 through 10,percent of total billed charges,,,
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16697.21,16697.21,16697.21,1 through 10,percent of total billed charges,,,
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,30352.04,29796.15,36514.58,1 through 10,percent of total billed charges,,,
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18098.81,18098.81,18098.81,1 through 10,percent of total billed charges,,,
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18432.98,18432.98,18432.98,1 through 10,percent of total billed charges,,,
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,65963.83,65963.83,65963.83,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,38339.92,38339.92,38339.92,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,60519.83,60519.83,60519.83,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,64567.53,64567.53,64567.53,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,50389.66,50389.66,50389.66,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,35899.47,35899.47,35899.47,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,29156.31,29156.31,29156.31,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,23948.53,23948.53,23948.53,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,34899.51,34899.51,34899.51,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,44940,44940,44940,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,46474.29,46474.29,46474.29,1 through 10,percent of total billed charges,,,
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,64171.07,64171.07,64171.07,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,8210.79,8210.79,8210.79,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,11503.28,11503.28,11503.28,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,20415.2,20415.2,20415.2,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,60318.05,60318.05,60318.05,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,11715.41,11715.41,11715.41,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,29295.24,29295.24,29295.24,1 through 10,percent of total billed charges,,,
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,50710.35,50710.35,50710.35,1 through 10,percent of total billed charges,,,
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,16786.67,16786.67,16786.67,1 through 10,percent of total billed charges,,,
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,31741.92,31741.92,31741.92,1 through 10,percent of total billed charges,,,
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19651.69,19651.69,19651.69,1 through 10,percent of total billed charges,,,
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,33658.07,33658.07,41713.66,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,199911.6,199911.6,199911.6,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,45370.09,45370.09,45370.09,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,78157.84,78157.84,78157.84,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,59706.78,47758.64,137411.19,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,33625.51,26429.8,61705.32,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,41688.63,41688.63,41688.63,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,33922.75,33922.75,33922.75,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,51852.1,51852.1,51852.1,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,37902.99,37902.99,37902.99,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,42915.02,39939.06,44623.07,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29533.99,27727.43,70074.6,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,34330.36,34330.36,43601.29,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,30660.52,30660.52,30660.52,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,40965.82,40965.82,40965.82,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,31464.31,24303.42,39626.87,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,27354.42,27354.42,27354.42,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,33897.49,27704.71,39083.94,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,37839.57,37839.57,37839.57,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,19528.59,19528.59,19528.59,1 through 10,percent of total billed charges,,,
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,29335.95,29335.95,29335.95,1 through 10,percent of total billed charges,,,
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,40151.65,40151.65,40151.65,1 through 10,percent of total billed charges,,,
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,43903.01,43903.01,43903.01,1 through 10,percent of total billed charges,,,
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,76931.86,76931.86,76931.86,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,41466.65,41466.65,98707.28,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,68602.44,68602.44,68602.44,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,130425.43,130425.43,130425.43,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,35322.3,32137.92,49437.22,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,33041.29,33041.29,33041.29,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,30715.91,30715.91,31995.49,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,38491.15,38491.15,38491.15,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,37537.58,37537.58,44424.43,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,19800.09,19800.09,19800.09,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,34636.7,34636.7,34636.7,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,31553.71,31553.71,106819.88,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,31919.97,31919.97,31919.97,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,45278.8,18863.34,51796.83,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,43904.09,43904.09,43904.09,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,53559.64,53559.64,53559.64,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,24111.94,24111.94,24111.94,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,48348.82,48348.82,83728.47,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,21408.85,21408.85,21408.85,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,36060.93,36060.93,36060.93,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,31574.59,31574.59,31574.59,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,214.36,214.36,214.36,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,29980.99,29980.99,29980.99,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,29774.03,29774.03,29774.03,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,40603.27,40603.27,40603.27,1 through 10,percent of total billed charges,,,
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,76398.66,76398.66,76398.66,1 through 10,percent of total billed charges,,,
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,25668.33,25668.33,25668.33,1 through 10,percent of total billed charges,,,
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,24870.12,24870.12,24870.12,1 through 10,percent of total billed charges,,,
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,12737.78,12737.78,12737.78,1 through 10,percent of total billed charges,,,
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,42919.51,42919.51,42919.51,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,31897.39,31897.39,31897.39,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,24243.43,24243.43,24243.43,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,41328.74,41328.74,41328.74,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21785.48,21785.48,21785.48,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,22767.68,22767.68,22767.68,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,71851.2,71851.2,71851.2,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,137821.72,137821.72,137821.72,1 through 10,percent of total billed charges,,,
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,39718.98,39718.98,39718.98,1 through 10,percent of total billed charges,,,
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,570071.1,570071.1,570071.1,1 through 10,percent of total billed charges,,,
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15708.88,15708.88,22518.97,1 through 10,percent of total billed charges,,,
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,19914.64,19914.64,19914.64,1 through 10,percent of total billed charges,,,
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,83340.86,83340.86,83340.86,1 through 10,percent of total billed charges,,,
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,55302.71,55302.71,55302.71,1 through 10,percent of total billed charges,,,
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,4105.53,4105.53,4105.53,1 through 10,percent of total billed charges,,,
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,10590.73,10590.73,10590.73,1 through 10,percent of total billed charges,,,
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,31814.75,26115.26,52992.62,1 through 10,percent of total billed charges,,,
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,39667.3,39667.3,39667.3,1 through 10,percent of total billed charges,,,
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,20961.2,20961.2,20961.2,1 through 10,percent of total billed charges,,,
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8636.02,8636.02,8636.02,1 through 10,percent of total billed charges,,,
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,42127.08,42127.08,42127.08,1 through 10,percent of total billed charges,,,
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,13426.08,13426.08,13426.08,1 through 10,percent of total billed charges,,,
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,57202.45,57202.45,57202.45,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,65987.8,65987.8,65987.8,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,45104.82,45104.82,45104.82,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,28359.67,28359.67,28359.67,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,22819.27,22819.27,22819.27,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,31627.46,31627.46,31627.46,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,15011.11,15011.11,15011.11,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,25130.41,25130.41,25130.41,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,30296.73,30296.73,30296.73,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,28823.58,28823.58,28823.58,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,60512.94,60512.94,60512.94,1 through 10,percent of total billed charges,,,
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,71209.23,71209.23,71209.23,1 through 10,percent of total billed charges,,,
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,22347.41,22347.41,22347.41,1 through 10,percent of total billed charges,,,
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,51203.05,51203.05,51203.05,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,41789.19,41789.19,41789.19,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,67391.45,67391.45,67391.45,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,43855.39,43855.39,43855.39,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,62538.59,62538.59,62538.59,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,45705.71,35843.96,88959.77,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,28077.11,28077.11,28077.11,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,41362.74,41362.74,41362.74,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,46749.03,46749.03,46749.03,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,48174.08,48174.08,48174.08,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,26031.24,26031.24,26031.24,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,27816.76,27816.76,31514.61,1 through 10,percent of total billed charges,,,
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,24738.3,24738.3,24738.3,1 through 10,percent of total billed charges,,,
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,147413.22,147413.22,147413.22,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,16081.25,16081.25,16081.25,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6174.35,6174.35,32184.73,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,24773.72,24773.72,24773.72,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,14841.55,14841.55,14841.55,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4257.32,4257.32,4257.32,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11760.25,11760.25,11760.25,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5295.79,5295.79,5295.79,1 through 10,percent of total billed charges,,,
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12960.55,12960.55,12960.55,1 through 10,percent of total billed charges,,,
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6308.84,4397.27,12316.31,1 through 10,percent of total billed charges,,,
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,687.87,687.87,687.87,1 through 10,percent of total billed charges,,,
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,3012.52,3012.52,3012.52,1 through 10,percent of total billed charges,,,
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,27917.08,27917.08,27917.08,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,17329.05,17329.05,17329.05,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,16315.93,16315.93,16315.93,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,26846.79,26846.79,26846.79,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10443.95,10443.95,10967.79,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3265.02,3265.02,3265.02,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,13901.76,13901.76,13901.76,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,11114.54,11114.54,11114.54,1 through 10,percent of total billed charges,,,
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,7664.6,7664.6,55626.9,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,50651.76,50651.76,50651.76,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,53603.16,53603.16,53603.16,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,48814.27,48814.27,48814.27,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,27267.58,27267.58,27267.58,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,22883.38,22883.38,22883.38,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,23422.83,23422.83,23422.83,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22340.69,22340.69,22340.69,1 through 10,percent of total billed charges,,,
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,1038.85,1038.85,1038.85,1 through 10,percent of total billed charges,,,
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,16359.96,16359.96,16359.96,1 through 10,percent of total billed charges,,,
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,19873.67,19873.67,19873.67,1 through 10,percent of total billed charges,,,
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,13440.01,13440.01,13440.01,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,35428.03,35428.03,35428.03,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,13807.41,13807.41,13807.41,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,18714.47,18714.47,18714.47,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11133.9,11133.9,11133.9,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,14776.76,14776.76,14776.76,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14701.01,14701.01,21143.97,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18770.8,18770.8,18770.8,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,15677.11,13935.89,30814.52,1 through 10,percent of total billed charges,,,
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7998.95,7544.09,14199.39,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,6320.28,6320.28,6320.28,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14724.07,10247.72,22747.74,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7216.31,7216.31,7216.31,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,133773.51,133773.51,133773.51,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,20024.88,10836.55,35258.85,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,6545.57,6545.57,6545.57,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7066.74,7066.74,14125.28,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,12647.27,12647.27,16771.14,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6706.25,5856.22,24809.7,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,12151.51,7540.92,45063.6,1 through 10,percent of total billed charges,,,
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,5261.25,5261.25,5261.25,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7257.94,7257.94,7257.94,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6499.14,6499.14,6499.14,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2319.31,2319.31,2319.31,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,54527.98,54527.98,54527.98,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5542.39,5542.39,5542.39,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3307.86,3307.86,3307.86,1 through 10,percent of total billed charges,,,
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7333.7,7333.7,7333.7,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,764.4,764.4,764.4,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4048.96,4048.96,4048.96,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,797.95,797.95,797.95,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15948.03,15948.03,15948.03,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,40825.29,31376.02,70274.13,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6852.85,6852.85,6852.85,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18515.76,18515.76,18515.76,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4586.18,4586.18,4586.18,1 through 10,percent of total billed charges,,,
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2920.44,2920.44,2920.44,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,11439.39,11439.39,11439.39,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,11992.6,11992.6,11992.6,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,7521.96,7521.96,7521.96,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,16673.94,16673.94,16673.94,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,13465.31,13465.31,13465.31,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6269.05,6269.05,10904.24,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,10553.82,10553.82,10553.82,1 through 10,percent of total billed charges,,,
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,33362.57,33362.57,33362.57,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,38799.11,38799.11,38799.11,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,31888.86,31888.86,31888.86,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,91324.51,91324.51,91324.51,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,45288.18,45288.18,45288.18,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21374.01,21374.01,21374.01,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,46625.71,46625.71,46625.71,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,25630.78,14225.87,68003.43,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,33292.28,33292.28,33292.28,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,38580.8,18704.2,84919.74,11,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,39266.06,27773.72,57657.5,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,74019,74019,74019,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,4958.56,4958.56,4958.56,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,31670.55,24101.28,49661.87,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,31687.84,31419.78,64514.49,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,40919.94,40919.94,40919.94,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,54894.62,54894.62,54894.62,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3746.68,3746.68,3746.68,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,21337.18,21337.18,36999.45,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27275.17,25332.2,43531.24,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,32928.16,25171.03,40864.22,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,23885.55,23885.55,23885.55,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,25409.46,25409.46,29160.38,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,18036.08,18036.08,45006.07,1 through 10,percent of total billed charges,,,
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,63889.65,63889.65,63889.65,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14198.93,14198.93,14198.93,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,36530,36530,36530,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7556.58,7556.58,7556.58,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19357.97,6338.47,22962.55,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,13259.47,13259.47,13259.47,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10788.02,10788.02,10788.02,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1101.52,1101.52,1101.52,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,6196.21,6196.21,6196.21,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,15499.17,15499.17,15499.17,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3185.39,3185.39,3185.39,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,9464.38,9464.38,9464.38,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,11326.17,11326.17,11326.17,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,11234.75,11234.75,11234.75,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,5270.45,5270.45,7388.97,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,4546.07,4546.07,4546.07,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,34035.36,34035.36,34035.36,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4613.25,4613.25,5751.47,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5416.83,5416.83,7927.07,1 through 10,percent of total billed charges,,,
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,50122.23,50122.23,50122.23,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10108.21,10108.21,10108.21,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8469.55,8469.55,8469.55,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,21845.09,21845.09,21845.09,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,8551.29,8551.29,8551.29,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,8584.12,8584.12,8584.12,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,26780.63,26780.63,26780.63,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,12868.57,7084.93,36830.57,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12274.86,12274.86,12274.86,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,6949.81,6949.81,6949.81,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,19942.78,19942.78,19942.78,1 through 10,percent of total billed charges,,,
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,59746.46,59746.46,59746.46,1 through 10,percent of total billed charges,,,
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24432.04,24432.04,24432.04,1 through 10,percent of total billed charges,,,
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,9401.05,9401.05,9401.05,1 through 10,percent of total billed charges,,,
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,8489.71,8489.71,8489.71,1 through 10,percent of total billed charges,,,
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,65900.6,65900.6,65900.6,1 through 10,percent of total billed charges,,,
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,26389.01,26389.01,26389.01,1 through 10,percent of total billed charges,,,
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,19465.01,19465.01,19465.01,1 through 10,percent of total billed charges,,,
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,45815.49,45815.49,45815.49,1 through 10,percent of total billed charges,,,
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27567.52,27567.52,27567.52,1 through 10,percent of total billed charges,,,
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11277.43,11277.43,11277.43,1 through 10,percent of total billed charges,,,
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,26252.91,26252.91,26252.91,1 through 10,percent of total billed charges,,,
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,38900.01,38900.01,38900.01,1 through 10,percent of total billed charges,,,
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,97532.09,97532.09,97532.09,1 through 10,percent of total billed charges,,,
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,48469.57,48469.57,48469.57,1 through 10,percent of total billed charges,,,
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,48619.62,48619.62,48619.62,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17584.66,15263.21,31389.53,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,31040.49,31040.49,31040.49,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,124961.95,124961.95,124961.95,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,28081.8,28081.8,28081.8,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,55478.09,55478.09,55478.09,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,71621.91,71621.91,71621.91,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,28059.51,28059.51,28059.51,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,36344.6,36344.6,36344.6,1 through 10,percent of total billed charges,,,
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27756.54,27756.54,27756.54,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,47308.45,47308.45,47308.45,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,210556.9,210556.9,210556.9,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,17077.86,17077.86,17077.86,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,19259.76,19259.76,19259.76,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16049.95,16049.95,16049.95,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,42724.4,42724.4,42724.4,1 through 10,percent of total billed charges,,,
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,85428.33,85428.33,85428.33,1 through 10,percent of total billed charges,,,
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,63575.35,63575.35,63575.35,1 through 10,percent of total billed charges,,,
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,81449.86,81449.86,81449.86,1 through 10,percent of total billed charges,,,
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5657.35,5657.35,5657.35,1 through 10,percent of total billed charges,,,
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,169364.2,169364.2,169364.2,1 through 10,percent of total billed charges,,,
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,101044.95,101044.95,101044.95,1 through 10,percent of total billed charges,,,
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6994.4,6994.4,6994.4,1 through 10,percent of total billed charges,,,
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,7944.86,7944.86,7944.86,1 through 10,percent of total billed charges,,,
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,17834.2,17834.2,17834.2,1 through 10,percent of total billed charges,,,
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,9632.42,9632.42,9632.42,1 through 10,percent of total billed charges,,,
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,17004.78,17004.78,17004.78,1 through 10,percent of total billed charges,,,
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,27177.89,17434.06,41535.57,1 through 10,percent of total billed charges,,,
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,8257.38,8257.38,8257.38,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,12199.89,12199.89,12199.89,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6697.62,6697.62,7820.11,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9093.15,9093.15,9093.15,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,10396.66,10396.66,12804.79,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14023.54,13425.92,15104.88,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,2901.04,2901.04,2901.04,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8431.7,3998.42,16763.83,23,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3501.64,2781,22192.14,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,16153.14,16153.14,16153.14,1 through 10,percent of total billed charges,,,
Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4596.26,4596.26,6423.1,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6442.49,6442.49,6442.49,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,26067.21,26067.21,26067.21,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,664.4,664.4,664.4,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17119.29,17119.29,17119.29,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,9759.42,9759.42,9759.42,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,13632.4,13632.4,13632.4,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10603.34,10603.34,10603.34,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8623.63,8623.63,8623.63,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7209.48,7209.48,7209.48,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7992.91,4725.43,25557.84,1 through 10,percent of total billed charges,,,
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,5578.54,5578.54,29131.17,1 through 10,percent of total billed charges,,,
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,15047.72,15047.72,15047.72,1 through 10,percent of total billed charges,,,
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,89763.31,89763.31,89763.31,1 through 10,percent of total billed charges,,,
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3959.79,3174.08,6096.77,1 through 10,percent of total billed charges,,,
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1349.02,1349.02,1349.02,1 through 10,percent of total billed charges,,,
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,24060.32,24060.32,24060.32,1 through 10,percent of total billed charges,,,
Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,37183.32,37183.32,37183.32,1 through 10,percent of total billed charges,,,
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,65898.34,65898.34,65898.34,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,85897.02,85897.02,85897.02,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,79389.12,79389.12,79389.12,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,373357.85,373357.85,373357.85,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,41068.83,41068.83,45420.38,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,42887.39,33285.34,87092.61,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,30832.91,30832.91,30832.91,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,34179.16,34179.16,34179.16,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,27749.75,23497.24,84135.27,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,41976.81,34553.67,55189.59,1 through 10,percent of total billed charges,,,
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,30016.64,24105.24,37175.84,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,31551.32,31551.32,31551.32,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,48585.08,48585.08,48585.08,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,34441.46,34441.46,34441.46,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,26553.42,26553.42,26553.42,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,28109.42,21354.85,33701.68,14,percent of total billed charges,,,
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,24999.72,19640.97,34176.55,19,percent of total billed charges,,,
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,28780,28780,28780,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,35307.33,35307.33,35307.33,1 through 10,percent of total billed charges,,,
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,15037.72,15037.72,15037.72,1 through 10,percent of total billed charges,,,
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,39751.52,39751.52,39751.52,1 through 10,percent of total billed charges,,,
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9918.62,9918.62,9918.62,1 through 10,percent of total billed charges,,,
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8428.5,8428.5,8428.5,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,15291.74,15291.74,15291.74,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,11514.46,11514.46,11514.46,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,471.15,471.15,471.15,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,23009.28,23009.28,49040.7,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,100903,100903,100903,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,14422.93,9798.71,27661.59,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,9229.99,9229.99,9229.99,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,17071.09,17071.09,17071.09,1 through 10,percent of total billed charges,,,
Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,5458.69,5458.69,5458.69,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,15538.65,15538.65,15960.36,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10580.52,10358.84,11237.51,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9395.75,8927.4,25846.62,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,11411.57,11411.57,11411.57,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,34237.27,34237.27,34237.27,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,22903.73,22903.73,22903.73,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,4246.02,4246.02,4246.02,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,11309.44,11309.44,11309.44,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,13344.39,13344.39,13344.39,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,4017.42,4017.42,4017.42,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10243.89,9736.66,10513.7,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,13341.34,13341.34,49712.24,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11222.55,8240.36,35509.79,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2747.55,2747.55,2747.55,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7155.3,7155.3,7287.68,1 through 10,percent of total billed charges,,,
Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,3941.06,3941.06,3941.06,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,19092.59,19092.59,19092.59,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,22317.15,22317.15,22317.15,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,15326,15326,15672.6,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,559.53,559.53,559.53,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7630.47,7630.47,8599.83,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7911.12,7911.12,7911.12,1 through 10,percent of total billed charges,,,
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19022.52,9191.83,23485.36,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,38968.62,38968.62,38968.62,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,22226.65,22226.65,22226.65,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9325.54,9325.54,11030.77,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,14004.09,14004.09,14004.09,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,29873.85,29873.85,29873.85,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,32021.5,32021.5,120871.66,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,5504.99,5504.99,5504.99,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16492.35,10444.28,55256.29,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,25838.58,19363.75,41205.66,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,27603.56,27603.56,27603.56,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4236.63,4236.63,4622.13,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,8061.92,8061.92,8061.92,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,2498.56,2498.56,2498.56,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,16401.42,16401.42,16401.42,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,26179.29,26179.29,26179.29,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,3435.53,2472.75,25434.61,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,5695.3,5695.3,5695.3,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4862.65,2777.58,12914.74,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3595.71,3595.71,3595.71,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3827.1,3827.1,4674.56,1 through 10,percent of total billed charges,,,
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,39100.67,39100.67,39100.67,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,21992.48,21992.48,21992.48,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,25774.63,21959.31,32552.64,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,60565.4,60565.4,60565.4,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9694.58,8448.84,84270.72,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,729.46,729.46,729.46,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,20874.49,20874.49,20874.49,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12449.04,12449.04,23604.66,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,5008.04,5008.04,5008.04,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5419.43,5419.43,5419.43,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13568.04,13568.04,13568.04,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10946.01,10946.01,10946.01,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,3838.93,3838.93,3838.93,1 through 10,percent of total billed charges,,,
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4756.09,4756.09,4756.09,1 through 10,percent of total billed charges,,,
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,9309.35,9309.35,9309.35,1 through 10,percent of total billed charges,,,
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,9425.44,9425.44,9425.44,1 through 10,percent of total billed charges,,,
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3574.93,3574.93,3574.93,1 through 10,percent of total billed charges,,,
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6601.81,6601.81,6601.81,1 through 10,percent of total billed charges,,,
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2446.93,2446.93,2446.93,1 through 10,percent of total billed charges,,,
Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8057.59,8057.59,8057.59,1 through 10,percent of total billed charges,,,
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,40445.12,40445.12,40445.12,1 through 10,percent of total billed charges,,,
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,47865.92,47865.92,47865.92,1 through 10,percent of total billed charges,,,
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,21955.07,21955.07,21955.07,1 through 10,percent of total billed charges,,,
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,19766.67,19766.67,19766.67,1 through 10,percent of total billed charges,,,
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,69753.09,69753.09,69753.09,1 through 10,percent of total billed charges,,,
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,29563.76,29563.76,29563.76,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,64948.1,64948.1,64948.1,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27917.78,27917.78,27917.78,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,55392.82,55392.82,55392.82,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,56403.06,56403.06,56403.06,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,43876.72,43876.72,43876.72,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,33662.94,33662.94,33662.94,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7675.22,7675.22,7675.22,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,23738.19,23738.19,23738.19,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,14365.59,14365.59,14365.59,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,27135.36,27135.36,27135.36,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,19092.98,19092.98,19092.98,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9128.34,9128.34,9128.34,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,25460.69,25460.69,25460.69,1 through 10,percent of total billed charges,,,
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,14006.6,14006.6,14006.6,1 through 10,percent of total billed charges,,,
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27561.64,27561.64,27561.64,1 through 10,percent of total billed charges,,,
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,18675.26,18675.26,18675.26,1 through 10,percent of total billed charges,,,
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,42612.4,42612.4,42612.4,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,91563.51,91563.51,91563.51,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,12058.04,12058.04,12058.04,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,58645.82,58645.82,58645.82,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,41815.01,41815.01,41815.01,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,52448.24,52448.24,52448.24,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,42871.1,42871.1,42871.1,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17768.31,17768.31,17768.31,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,61150.61,61150.61,61150.61,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,15236.37,9769.62,16731.54,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,16643.29,15661.08,47755.46,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,32697.91,32697.91,32697.91,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,749.11,749.11,749.11,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,31757.51,21586.95,61407.7,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14131.73,8611.12,44211.4,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,29529.2,29529.2,29529.2,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8842.89,6789.95,109553.41,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3152.05,3152.05,3152.05,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9820.04,3130.4,32726.1,1 through 10,percent of total billed charges,,,
Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,5806.07,5510.55,8546.5,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,8732.17,8732.17,8732.17,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,10233.28,10233.28,10233.28,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9929.38,9929.38,9929.38,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,12287.49,12287.49,15519.65,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,16884.03,16884.03,16884.03,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,14731.17,10844.35,32648.82,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7708.74,6964.36,18339.08,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,9457.58,9457.58,9457.58,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9449.12,9449.12,10068.24,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,8127.92,8127.92,8127.92,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4465.56,2311.61,9092.33,1 through 10,percent of total billed charges,,,
Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,2539.07,2539.07,2539.07,1 through 10,percent of total billed charges,,,
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,7397.99,7397.99,7397.99,1 through 10,percent of total billed charges,,,
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,11039.93,11039.93,11039.93,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,21426.9,21426.9,21426.9,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,25599.17,25599.17,25599.17,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,14689.19,14689.19,25587.31,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,13400.6,13263.8,200747.42,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13233.7,13233.7,13233.7,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,15320.96,15320.96,15320.96,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,18110.16,18110.16,18110.16,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17184.35,17184.35,17184.35,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20522.72,20522.72,20522.72,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,22334.96,22334.96,31066.6,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,7266.28,3555.97,33624.69,16,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,11740.66,11740.66,11740.66,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,7596.86,7596.86,15499.99,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,11824.83,11824.83,11824.83,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,17936.45,17936.45,17936.45,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,19472.42,19472.42,19472.42,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,9825.83,9825.83,15487,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,12670.72,12670.72,12670.72,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,7741.58,5274.98,8848.25,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,16159.61,15726.65,20167.02,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6976.3,3592.13,11856.43,12,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9139.65,4080.44,21028.07,1 through 10,percent of total billed charges,,,
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,7300.46,7300.46,7300.46,1 through 10,percent of total billed charges,,,
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,3638.44,3638.44,3638.44,1 through 10,percent of total billed charges,,,
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,20900.93,20900.93,20900.93,1 through 10,percent of total billed charges,,,
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,5787.01,5787.01,5787.01,1 through 10,percent of total billed charges,,,
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10707.3,10707.3,10707.3,1 through 10,percent of total billed charges,,,
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,10991.3,10991.3,10991.3,1 through 10,percent of total billed charges,,,
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,12078.72,12078.72,12078.72,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,6193.45,6193.45,6193.45,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,20734.83,20734.83,22278.49,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,17359.3,17359.3,20852.99,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,36163.56,36163.56,36163.56,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,8237.22,8237.22,8237.22,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,32851.79,32851.79,32851.79,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,9571.58,9571.58,11172.73,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,61229.4,61229.4,61229.4,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18710.64,18710.64,18710.64,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,17749.63,17749.63,17749.63,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,64314.74,64314.74,64314.74,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,24343.31,24343.31,24343.31,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,32640.8,32640.8,32640.8,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,8979.08,8979.08,8979.08,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,21167.6,21167.6,68741.61,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6383.07,6383.07,6383.07,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,15206.72,15206.72,15206.72,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,39785.35,39785.35,39785.35,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,7435.22,7435.22,7435.22,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8743.21,8743.21,8743.21,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,5879.99,5879.99,5879.99,1 through 10,percent of total billed charges,,,
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,133479.18,133479.18,133479.18,1 through 10,percent of total billed charges,,,
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,33636.11,33636.11,33636.11,1 through 10,percent of total billed charges,,,
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,19647.66,19647.66,19647.66,1 through 10,percent of total billed charges,,,
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,31507.02,31507.02,31507.02,1 through 10,percent of total billed charges,,,
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,14141.7,14141.7,14141.7,1 through 10,percent of total billed charges,,,
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,21735.65,21735.65,38030.61,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,30654.08,30654.08,30654.08,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,15896.66,15896.66,15896.66,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,21991.75,21991.75,21991.75,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23306.19,23306.19,23306.19,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,29896.96,29896.96,29896.96,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18105.67,18105.67,18105.67,1 through 10,percent of total billed charges,,,
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,28918.04,28918.04,28918.04,1 through 10,percent of total billed charges,,,
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,23475.07,23475.07,23475.07,1 through 10,percent of total billed charges,,,
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5796.95,5796.95,5796.95,1 through 10,percent of total billed charges,,,
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,25320.75,25320.75,25320.75,1 through 10,percent of total billed charges,,,
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,6854.51,6854.51,6854.51,1 through 10,percent of total billed charges,,,
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1455.83,1455.83,1455.83,1 through 10,percent of total billed charges,,,
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,13541.89,13541.89,13541.89,1 through 10,percent of total billed charges,,,
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,15117.25,15117.25,15117.25,1 through 10,percent of total billed charges,,,
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,43980.96,43980.96,43980.96,1 through 10,percent of total billed charges,,,
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,13734.52,13734.52,13734.52,1 through 10,percent of total billed charges,,,
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,22063.56,13557.97,31253.47,17,percent of total billed charges,,,
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,11537.41,11537.41,11537.41,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,36683.87,36683.87,36683.87,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24743.42,24743.42,24743.42,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11111.16,11111.16,11111.16,1 through 10,percent of total billed charges,,,
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,12061.05,12061.05,12061.05,1 through 10,percent of total billed charges,,,
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21688.6,21688.6,21688.6,1 through 10,percent of total billed charges,,,
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,5012.53,5012.53,5012.53,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18061.58,18061.58,18061.58,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,5209.82,5209.82,6305.7,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6909.27,2471.91,7507.06,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1417.31,1417.31,1417.31,1 through 10,percent of total billed charges,,,
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3008.77,3008.77,3008.77,1 through 10,percent of total billed charges,,,
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,61799.09,61799.09,61799.09,1 through 10,percent of total billed charges,,,
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9867.51,9867.51,9867.51,1 through 10,percent of total billed charges,,,
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,16603.94,16603.94,16603.94,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,25701.24,17149.26,31123.65,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,12963.94,12963.94,12963.94,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,13231.99,13231.99,13231.99,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11858.17,11858.17,11858.17,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14291.28,14291.28,14291.28,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16443.99,12099.68,21471.99,11,percent of total billed charges,,,
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,16582.77,13762.45,19993.98,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17004.64,17004.64,17004.64,1 through 10,percent of total billed charges,,,
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12731.54,11290.79,16934.33,17,percent of total billed charges,,,
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,74306.06,74306.06,74306.06,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,30750.85,30750.85,30750.85,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,25712.15,25712.15,25712.15,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,27588.48,27588.48,27588.48,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,17935.59,17935.59,19264.28,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,18244.4,18244.4,21611.95,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24036.04,16472.75,43191.28,19,percent of total billed charges,,,
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,38221.7,31489.98,42243.23,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,24072.54,20214.34,46813.49,12,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17794.62,16245.87,115214.3,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,28498.29,28498.29,32476.68,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,23925.26,19011.86,40894.76,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16029.62,12100.82,34236.53,32,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,17135.42,17135.42,17135.42,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,17162.8,17162.8,17162.8,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,20383.25,12222.09,29706.09,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,20570.31,17761.77,32418.89,12,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23497.19,17309.64,45338.01,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,12413.96,12413.96,12413.96,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,33837.31,33837.31,33837.31,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15989.46,12702.77,21938.46,33,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,38465.47,38465.47,38465.47,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,34385.57,34385.57,34385.57,1 through 10,percent of total billed charges,,,
Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,131365.86,131365.86,143369.66,1 through 10,percent of total billed charges,,,
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,116602.48,116602.48,116602.48,1 through 10,percent of total billed charges,,,
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,317848.17,317848.17,317848.17,1 through 10,percent of total billed charges,,,
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,25438.66,25438.66,25438.66,1 through 10,percent of total billed charges,,,
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,86383.18,33219.63,178607.81,29,percent of total billed charges,,,
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,224668.69,96851.74,339431.59,1 through 10,percent of total billed charges,,,
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,149287.72,149287.72,149287.72,1 through 10,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,107364.95,107364.95,129436.21,1 through 10,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,2519.9,2519.9,2519.9,1 through 10,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,85294.37,85294.37,85294.37,1 through 10,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,33315.83,5977.87,97180.86,14,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,2512.23,2512.23,2512.23,1 through 10,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,54305.62,54305.62,101660.6,1 through 10,percent of total billed charges,,,
Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,25492.18,25492.18,25492.18,1 through 10,percent of total billed charges,,,
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,48228.05,48228.05,48228.05,1 through 10,percent of total billed charges,,,
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,1675.39,1675.39,1675.39,1 through 10,percent of total billed charges,,,
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,2017.51,1548.72,10571.79,13,percent of total billed charges,,,
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,182.15,182.15,182.15,1 through 10,percent of total billed charges,,,
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,9382.94,9382.94,9382.94,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,6532.94,6503.69,36126.07,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,29752.87,29752.87,29752.87,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,27980.32,27980.32,27980.32,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,13020.86,13020.86,15929.49,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,5424.1,5424.1,5424.1,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4126.3,1559.36,22919.85,29,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3751.32,3751.32,3751.32,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,5588.84,5588.84,54667.43,1 through 10,percent of total billed charges,,,
Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,1834.43,1086.12,7074.41,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3149.61,3149.61,6013.72,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3334.45,1651.19,65899.08,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1449.15,1449.15,1449.15,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,1841.01,858.17,23162.94,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,2034.12,1499.53,24867.65,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,918.73,918.73,918.73,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1550.07,914.37,2984.37,189,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1906.82,1464.14,2540.91,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1690.52,1459.37,14531.24,1 through 10,percent of total billed charges,,,
Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,1472.82,1038.49,1781.51,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,945.84,945.84,1155.43,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,1446.43,1446.43,2345.69,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,1611.85,1574.79,2329.57,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,1608.83,1586.79,2118.55,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1423.03,819.92,2192.36,184,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1058.36,1058.36,1203.83,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1484.74,1417.79,1893.23,1 through 10,percent of total billed charges,,,
Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18560.25,14513.25,21847.86,1 through 10,percent of total billed charges,,,
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17474.65,17474.65,17474.65,1 through 10,percent of total billed charges,,,
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16863.81,13996.74,21077.4,14,percent of total billed charges,,,
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,19928.52,19928.52,19928.52,1 through 10,percent of total billed charges,,,
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23158.51,20036.5,43055.03,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,18924.33,18924.33,18924.33,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,27679.59,27679.59,27679.59,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,19331.09,19331.09,19331.09,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,17490.23,13923.94,22986.44,24,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,17772.13,17772.13,25401.63,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,32161.66,32161.66,32161.66,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,17335.87,17335.87,32851.35,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,15347.3,13871.9,16643.3,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,16342.26,12098.38,21516.5,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,19126.91,18043.64,26253.06,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,36787.14,36787.14,36787.14,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,14234.55,14234.55,14234.55,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16558.38,11586.1,22167.86,76,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,23087.42,23087.42,23087.42,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,14092.2,13979.46,18172.29,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,14204.23,12893.69,20271.3,11,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,18714.22,14314.66,28145.65,29,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18622.81,14157.57,26019.66,25,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,18032.12,18032.12,23545.16,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,14587.31,13711.21,30436.48,11,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,19944.85,15824.68,25220.77,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15052.88,11249.73,24640.68,163,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,14978.45,7249.85,18652.08,11,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,14999.09,14255.78,17063.79,1 through 10,percent of total billed charges,,,
Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,14578.28,14578.28,14578.28,1 through 10,percent of total billed charges,,,
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16005.17,16005.17,16005.17,1 through 10,percent of total billed charges,,,
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6058.6,6058.6,6058.6,1 through 10,percent of total billed charges,,,
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18841.07,18841.07,18841.07,1 through 10,percent of total billed charges,,,
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2745.99,2745.99,2745.99,1 through 10,percent of total billed charges,,,
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8108.74,8108.74,8108.74,1 through 10,percent of total billed charges,,,
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14272.8,14272.8,14272.8,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,15964.99,15964.99,15964.99,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,17191.41,17191.41,17191.41,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6410.19,6410.19,34751.59,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,16922.56,16922.56,16922.56,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4671.59,4671.59,4671.59,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,17374.66,17374.66,20571.41,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9330.04,6199.02,10649.4,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,5182.83,5182.83,5182.83,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,3086.6,3086.6,5267.61,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,7852.69,7852.69,7852.69,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6326.09,6326.09,6326.09,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11000.15,4258.1,31172.71,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2735.43,2735.43,2735.43,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,7302.86,7302.86,9854.79,1 through 10,percent of total billed charges,,,
Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,37781.62,37781.62,37781.62,1 through 10,percent of total billed charges,,,
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11779.62,11779.62,11779.62,1 through 10,percent of total billed charges,,,
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,24536.51,24536.51,24536.51,1 through 10,percent of total billed charges,,,
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,84608.51,84608.51,84608.51,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,59638.62,59638.62,59638.62,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,17937.5,17937.5,17937.5,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9780.15,9780.15,9780.15,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,5373.82,5373.82,5373.82,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,803.15,803.15,803.15,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,26656.52,26656.52,26656.52,1 through 10,percent of total billed charges,,,
Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,7647.89,7647.89,7647.89,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,26492.34,26492.34,26492.34,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,18843.03,18843.03,18843.03,1 through 10,percent of total billed charges,,,
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,45878.29,45878.29,45878.29,1 through 10,percent of total billed charges,,,
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,33885.38,33885.38,33885.38,1 through 10,percent of total billed charges,,,
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,8247.31,8247.31,17662.73,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,13411.89,13411.89,13411.89,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,4452.32,4452.32,4452.32,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6089.17,3976.79,14895.94,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,14217.86,14217.86,14217.86,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5374.87,5374.87,5374.87,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,2102.74,2102.74,2102.74,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3432.6,2568.55,7264.35,1 through 10,percent of total billed charges,,,
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,120646.78,120646.78,120646.78,1 through 10,percent of total billed charges,,,
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18790.81,18790.81,18790.81,1 through 10,percent of total billed charges,,,
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,12490.85,12490.85,12490.85,1 through 10,percent of total billed charges,,,
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,9605.14,9605.14,9605.14,1 through 10,percent of total billed charges,,,
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,129476.77,63473.41,174691.74,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,83437.32,83437.32,83437.32,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,114096.31,61587.23,133580.9,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,105031.46,105031.46,827291.84,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,58634.11,58634.11,58634.11,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,57711.56,57711.56,57711.56,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,69304.88,69304.88,109928.92,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,67608.49,41094.26,299978.84,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,57758.19,57758.19,128183.85,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,61517.97,32555.92,145987.88,12,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,111176.15,52083.68,157032.32,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,88629.22,88629.22,88629.22,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,81836.37,42266.61,162252.46,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,66381.98,66381.98,66381.98,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,15261.32,15261.32,15261.32,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,46735.01,46735.01,46735.01,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,38741.43,38741.43,38741.43,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,94059.61,94059.61,94059.61,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,40035.85,40035.85,40035.85,1 through 10,percent of total billed charges,,,
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,43807.31,43807.31,43807.31,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,34238.01,34238.01,49513.95,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,152351.66,152351.66,152351.66,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,34977.29,34977.29,34977.29,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,113785.57,113785.57,113785.57,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,28642.11,28642.11,28642.11,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21379.56,14423.31,103735.84,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11954.37,11954.37,11954.37,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,47594.02,47594.02,47594.02,1 through 10,percent of total billed charges,,,
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,7602.42,7602.42,7602.42,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6122.23,6122.23,6122.23,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,12857.36,12857.36,12857.36,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,7886.16,7886.16,7886.16,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,7938.28,6535.16,17086.92,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,17844.62,17844.62,17844.62,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,12510,12510,12510,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,26521.44,26521.44,26521.44,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10060.88,10060.88,10060.88,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,18565.78,18565.78,18565.78,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,31661.33,31661.33,31661.33,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1140.19,1140.19,1140.19,1 through 10,percent of total billed charges,,,
Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10097.87,10097.87,10097.87,1 through 10,percent of total billed charges,,,
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,33549.48,33549.48,33549.48,1 through 10,percent of total billed charges,,,
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,29423.37,29423.37,29423.37,1 through 10,percent of total billed charges,,,
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11057.11,11057.11,11057.11,1 through 10,percent of total billed charges,,,
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,7491.58,7491.58,7491.58,1 through 10,percent of total billed charges,,,
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4928.89,4928.89,4928.89,1 through 10,percent of total billed charges,,,
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,8981.56,8981.56,8981.56,1 through 10,percent of total billed charges,,,
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,142236.54,142236.54,142236.54,1 through 10,percent of total billed charges,,,
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,46981.59,46981.59,46981.59,1 through 10,percent of total billed charges,,,
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,10539.31,10539.31,10539.31,1 through 10,percent of total billed charges,,,
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,15556.66,15556.66,15556.66,1 through 10,percent of total billed charges,,,
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,78132.36,78132.36,78132.36,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,126191.81,113739.33,280913.99,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,57309.15,57309.15,57309.15,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,63450.68,63450.68,63450.68,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,113334.21,113334.21,113334.21,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,123961.95,123961.95,123961.95,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,97851.77,97851.77,97851.77,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,402685.76,402685.76,402685.76,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,87924.74,87924.74,87924.74,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,29041.12,11966.82,100893.02,30,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,13315.45,13315.45,13315.45,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,17934.25,9382.14,46622.98,27,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,23944.31,17354.8,75304.92,16,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,22257.64,8035.38,155883.81,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,16542.49,13342.83,16928.86,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,28518.04,27195,79741.8,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,37560.24,24981.15,65680.41,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,19715.86,10362.25,54044.48,11,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,15678.9,15678.9,67225.78,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,20829.21,10080.1,85052.38,15,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,21660.8,12648.4,219552.04,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20215.9,10284.99,39573.84,31,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,41765.74,23572.25,55276.31,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,31216.43,11932.82,79694.52,11,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,23382.43,11823.5,52884.48,42,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,10813.02,7437.11,53307.46,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,10563.87,10563.87,10563.87,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,29728.5,26998.22,41753.42,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,11650.11,11650.11,15712.8,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,8923.71,8923.71,13757.27,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,11812.07,11812.07,11812.07,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,13173.64,13173.64,13173.64,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5851.94,5851.94,5851.94,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,25344.8,25344.8,25344.8,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,10840.34,10840.34,11946.6,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,7434.13,7434.13,7434.13,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9615.44,6260.25,47432.69,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,26450.32,26450.32,26450.32,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,12623.7,10201.56,81502.36,1 through 10,percent of total billed charges,,,
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,64201.86,64201.86,64201.86,1 through 10,percent of total billed charges,,,
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,78762.66,78762.66,78762.66,1 through 10,percent of total billed charges,,,
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6913.96,6913.96,6913.96,1 through 10,percent of total billed charges,,,
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,24138.56,24138.56,24138.56,1 through 10,percent of total billed charges,,,
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,35866.21,35866.21,35866.21,1 through 10,percent of total billed charges,,,
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,6023.58,6023.58,13488.54,1 through 10,percent of total billed charges,,,
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,8444.55,8444.55,8444.55,1 through 10,percent of total billed charges,,,
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,3036.71,3036.71,3036.71,1 through 10,percent of total billed charges,,,
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,4693.9,4693.9,8305.18,1 through 10,percent of total billed charges,,,
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3885.44,3885.44,3885.44,1 through 10,percent of total billed charges,,,
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,7302.02,7302.02,7302.02,1 through 10,percent of total billed charges,,,
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,6186.3,6186.3,6186.3,1 through 10,percent of total billed charges,,,
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,23939.19,23939.19,23939.19,1 through 10,percent of total billed charges,,,
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11830.11,11830.11,11830.11,1 through 10,percent of total billed charges,,,
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8656.78,8656.78,38258.26,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,12076.54,12076.54,16619.2,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,12603.54,7952.5,31945.08,20,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18395.09,11579.71,29418.84,12,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,19406.89,19406.89,39175.31,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,15833.35,5939.08,59171.81,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,31793.47,31793.47,31793.47,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,24784.59,24784.59,24784.59,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,49974.46,49974.46,49974.46,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,24396.65,24396.65,47806.34,1 through 10,percent of total billed charges,,,
Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5823.93,5823.93,5823.93,1 through 10,percent of total billed charges,,,
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,19937.23,19937.23,19937.23,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,13627.46,13627.46,13627.46,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,29679.44,29679.44,29679.44,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,14106.5,14106.5,48554.15,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,5495.17,5495.17,5495.17,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,38693.3,38693.3,38693.3,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,6121.23,6121.23,6121.23,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,16094.95,8128.2,79867.04,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,20195.42,20195.42,22639.21,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,2867.81,2687.38,3068.37,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,5719.16,3045.93,5824.79,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,3213.89,1929.29,8294.02,26,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,3148.06,1744.87,4760.95,26,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,16448.35,16448.35,16448.35,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,16276.68,16276.68,66914.06,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,3088.5,2226.05,6565.45,12,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,4529.12,3394.85,5055.3,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,4864.45,4098.02,6042.97,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,4192.32,1329.12,19991.7,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,6119.34,1821.9,9992.13,18,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3159.53,2194.68,4698.17,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,3827.39,1617,10227.57,1 through 10,percent of total billed charges,,,
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,1248.17,760.69,6081.01,13,percent of total billed charges,,,
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,142910.29,142910.29,142910.29,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,119617.34,43935.26,165807.32,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,324105.94,324105.94,324105.94,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20186.31,20186.31,20186.31,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,119294.6,119294.6,119294.6,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,13061.69,13061.69,13061.69,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,16516.08,16516.08,16516.08,1 through 10,percent of total billed charges,,,
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25591.9,25591.9,25591.9,1 through 10,percent of total billed charges,,,
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,16992.64,16992.64,16992.64,1 through 10,percent of total billed charges,,,
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,34390.5,34390.5,34390.5,1 through 10,percent of total billed charges,,,
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,14449.98,14449.98,14449.98,1 through 10,percent of total billed charges,,,
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,78153.31,78153.31,78153.31,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,47307.78,47307.78,47307.78,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,65076.85,65076.85,65076.85,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,25021.69,25021.69,25021.69,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,38692.36,38692.36,38692.36,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,81444.1,81444.1,81444.1,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,68526.68,68526.68,68526.68,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,27475.94,27475.94,27475.94,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12315.84,12315.84,13562.28,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,69576.25,69576.25,69576.25,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,680,680,680,1 through 10,percent of total billed charges,,,
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,18036.31,18036.31,18036.31,1 through 10,percent of total billed charges,,,
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,10143.81,10143.81,10143.81,1 through 10,percent of total billed charges,,,
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,1145.25,1145.25,1145.25,1 through 10,percent of total billed charges,,,
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,3699.83,3699.83,3699.83,1 through 10,percent of total billed charges,,,
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,5057.14,5057.14,5057.14,1 through 10,percent of total billed charges,,,
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,113491.43,99141.92,127887.39,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,1101.52,1101.52,1101.52,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8073.49,8073.49,8073.49,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,16525.29,16525.29,16525.29,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,34080.54,34080.54,34080.54,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,41790.21,41790.21,41790.21,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,9287.27,9287.27,9287.27,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24437.89,10701.37,96791.14,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,12921.74,12921.74,16372.68,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,12728.65,9829.68,37014.51,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,9667.4,9667.4,9667.4,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,9754.24,9754.24,15210.8,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,8502.04,8502.04,10253.31,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,19415.41,19415.41,19415.41,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13024.77,13024.77,13024.77,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,9231.56,4857.31,15265.61,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,4175.03,4175.03,7482.54,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,1608.03,1608.03,1608.03,1 through 10,percent of total billed charges,,,
Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,8838.63,8838.63,8838.63,1 through 10,percent of total billed charges,,,
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11941.76,11941.76,11941.76,1 through 10,percent of total billed charges,,,
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10272.67,10272.67,10272.67,1 through 10,percent of total billed charges,,,
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,18489.39,18489.39,18489.39,1 through 10,percent of total billed charges,,,
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,1546.11,1546.11,1546.11,1 through 10,percent of total billed charges,,,
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,4253.14,4253.14,4253.14,1 through 10,percent of total billed charges,,,
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,2469.93,2469.93,2469.93,1 through 10,percent of total billed charges,,,
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6822.55,6822.55,16157.41,1 through 10,percent of total billed charges,,,
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,41810.3,41810.3,41810.3,1 through 10,percent of total billed charges,,,
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,5577.41,5577.41,5577.41,1 through 10,percent of total billed charges,,,
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,13738.75,13738.75,13738.75,1 through 10,percent of total billed charges,,,
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16893.12,16893.12,16893.12,1 through 10,percent of total billed charges,,,
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,84074.49,84074.49,84074.49,1 through 10,percent of total billed charges,,,
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,2494.74,2494.74,2494.74,1 through 10,percent of total billed charges,,,
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,26941.01,26941.01,26941.01,1 through 10,percent of total billed charges,,,
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,634963.84,634963.84,1015134.93,1 through 10,percent of total billed charges,,,
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,441136.31,441136.31,441136.31,1 through 10,percent of total billed charges,,,
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,420063.43,420063.43,420063.43,1 through 10,percent of total billed charges,,,
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,110731.31,110731.31,110731.31,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,67893.36,67893.36,67893.36,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,76979.68,38498.79,105713,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,344747.65,344747.65,344747.65,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,688.46,688.46,688.46,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,14487.68,14487.68,14487.68,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,637378.24,637378.24,637378.24,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,20366.25,20366.25,20366.25,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,37246.19,37246.19,37246.19,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,21259.99,21259.99,21259.99,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,614300.38,614300.38,614300.38,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,31843.33,31843.33,31843.33,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,30492.29,30492.29,30492.29,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,43669.53,43669.53,43669.53,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,53400.63,53400.63,53400.63,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,27277.45,27277.45,27277.45,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,49793.2,49793.2,49793.2,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,16596.52,16596.52,16596.52,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,65017.7,65017.7,65017.7,1 through 10,percent of total billed charges,,,
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,42487.85,42487.85,42487.85,1 through 10,percent of total billed charges,,,
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,55284.75,55284.75,55284.75,1 through 10,percent of total billed charges,,,
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,532.12,532.12,532.12,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,18692.81,18692.81,18692.81,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,34434.49,16618.72,46492.6,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,19828,19828,29649.36,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,23742.62,23742.62,23742.62,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,6735.13,6735.13,10071.97,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24844.5,16092.29,36137.24,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,9326.91,9326.91,9326.91,1 through 10,percent of total billed charges,,,
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,16401.54,16401.54,119198.82,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,15744.38,6131.81,46372.39,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,16000.99,2983.39,83804.92,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,21011.06,21011.06,21011.06,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,3319.19,3319.19,3319.19,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,3239.73,2966.75,10722.26,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,40342.79,40342.79,40342.79,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,50275.14,50275.14,50275.14,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4486.81,1726.1,11329.65,11,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,3269.52,3269.52,11492.2,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,2033.88,2033.88,2033.88,1 through 10,percent of total billed charges,,,
Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,2922.02,2922.02,22370.88,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,28318.27,28318.27,28318.27,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,8512.09,8512.09,8512.09,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,18209.53,18209.53,18209.53,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,53857.26,53857.26,53857.26,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,73012.93,73012.93,73012.93,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,30178.71,30178.71,30178.71,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,82261.24,82261.24,82261.24,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,51533.21,51533.21,51533.21,1 through 10,percent of total billed charges,,,
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,45168.63,45168.63,45168.63,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,13139.52,13139.52,13139.52,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,27347.72,26137.04,79702.85,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,44674.61,44674.61,44674.61,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,64304.63,21195.53,114156.62,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,61639.86,61639.86,61639.86,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,55468.41,55468.41,55468.41,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,54730.53,54730.53,54730.53,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,78783.95,78783.95,78783.95,1 through 10,percent of total billed charges,,,
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,20802.09,20802.09,20802.09,1 through 10,percent of total billed charges,,,
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24793.36,24793.36,24793.36,1 through 10,percent of total billed charges,,,
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,6168.16,6168.16,6168.16,1 through 10,percent of total billed charges,,,
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,14508.19,14508.19,19745.01,1 through 10,percent of total billed charges,,,
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,1141.37,1141.37,1141.37,1 through 10,percent of total billed charges,,,
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,6606.38,6606.38,6606.38,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,16231.75,16231.75,16231.75,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,3347.01,3347.01,3347.01,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,10800.01,10800.01,10800.01,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,3913.43,3913.43,3913.43,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,11778.21,11778.21,11778.21,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,811.6,811.6,811.6,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,21251.04,21251.04,21251.04,1 through 10,percent of total billed charges,,,
Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,36873.76,15254.44,58967.63,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,35100.07,35100.07,42777.37,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,21484.91,21484.91,21484.91,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,38699.13,38699.13,38699.13,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,51587.95,51587.95,51587.95,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,4106.78,4106.78,4106.78,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19749.55,19749.55,19749.55,1 through 10,percent of total billed charges,,,
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,14739.41,14739.41,14739.41,1 through 10,percent of total billed charges,,,
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,32855.05,32855.05,32855.05,1 through 10,percent of total billed charges,,,
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,39092.04,39092.04,39092.04,1 through 10,percent of total billed charges,,,
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,1585.49,1585.49,1585.49,1 through 10,percent of total billed charges,,,
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,146964.88,146964.88,146964.88,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,48625.04,48625.04,48625.04,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,54565.24,54565.24,54565.24,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,180156.76,180156.76,180156.76,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,47616.47,47616.47,47616.47,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,70816.75,70816.75,70816.75,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,39331.9,39331.9,39331.9,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,105220.66,105220.66,105220.66,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,64971.62,64971.62,64971.62,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,69947.08,69947.08,69947.08,1 through 10,percent of total billed charges,,,
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,147132.44,147132.44,147132.44,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,93162.13,93162.13,93162.13,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,47789.57,47789.57,47789.57,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,58678.24,58678.24,58678.24,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,99718.47,99718.47,99718.47,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,96232.32,96232.32,96232.32,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,244807.39,244807.39,244807.39,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,107759.28,107759.28,112537.89,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,53084.88,53084.88,53084.88,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,71760.37,71760.37,71760.37,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,23866.26,23866.26,23866.26,1 through 10,percent of total billed charges,,,
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,39367.66,39367.66,39367.66,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,20810.31,20810.31,20810.31,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,30035.57,30035.57,30035.57,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,4170.73,4170.73,4170.73,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,39466.06,39466.06,39466.06,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,10182.16,10182.16,10182.16,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,11266.02,11266.02,11266.02,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,8336.87,8336.87,8336.87,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,8736.69,8736.69,8736.69,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,27932.47,27932.47,27932.47,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,11510.3,11510.3,11510.3,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,7000.88,7000.88,7000.88,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,9224.38,9224.38,74990.61,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6132.46,6132.46,6132.46,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,12771.5,12771.5,12771.5,1 through 10,percent of total billed charges,,,
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,37301.91,37301.91,37301.91,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,65752.14,65752.14,65752.14,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,41115.73,41115.73,42452.92,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,50753.96,50753.96,50753.96,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,22937.37,22937.37,22937.37,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,22611.36,22611.36,22611.36,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,6277.18,6277.18,6277.18,1 through 10,percent of total billed charges,,,
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,54395.95,31980.08,81194.58,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,57472.42,57472.42,181312.71,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,262503.81,262503.81,262503.81,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,100840.44,100840.44,100840.44,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,30593.6,30593.6,30593.6,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,41121.38,41121.38,41121.38,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,21444.23,21444.23,21444.23,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,25451.61,25451.61,25451.61,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,38865.49,38865.49,38865.49,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,20646.27,20646.27,20646.27,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,38919.25,38919.25,38919.25,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,24616.91,24616.91,24616.91,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,20890.44,20890.44,20890.44,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,7329.96,7329.96,7329.96,1 through 10,percent of total billed charges,,,
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,69866.24,69866.24,69866.24,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,55476.92,55476.92,55476.92,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,41253.62,41253.62,41253.62,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,95839.28,95839.28,95839.28,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,35481.38,35481.38,35481.38,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,39326.29,39326.29,39326.29,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,24366.86,24366.86,24366.86,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,30729.17,30729.17,30729.17,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,19539.05,19539.05,19539.05,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,15362.18,15362.18,15362.18,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,20912.74,20912.74,20912.74,1 through 10,percent of total billed charges,,,
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Other Commercial Plan,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Employee,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Ehp,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Humana,Military Tricare Government,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,All Commercial Plans,,100,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicaid Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Unitedhealthcare,Medicare Managed Care Plan,,92.3,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period.
Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-089-09),250,RC,33342-089-09,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-090-09),250,RC,33342-090-09,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-090-09),250,RC,33342-090-09,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-097-09)",250,RC,33342-097-09,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-256-66)  / 10 Capsule In 1 Blister Pack,250,RC,33342-256-66,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66)  / 10 Capsule In 1 Blister Pack,250,RC,33342-258-66,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66)  / 10 Capsule In 1 Blister Pack,250,RC,33342-258-66,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-089-09),250,RC,33342-089-09,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketoconazole: 30 Tablet In 1 Bottle (35573-433-30),250,RC,35573-433-30,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron Hydrochloride: 25 Vial, Single-Dose In 1 Carton (36000-012-25)  / 2 Ml In 1 Vial, Single-Dose",250,RC,36000-012-25,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,36000-162-01,NDC,,,facility,both,1,EA,,8.29,8.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose",250,RC,36000-282-25,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose",250,RC,36000-283-25,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,33342-087-02,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (33342-065-10)",250,RC,33342-065-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (31722-729-30),250,RC,31722-729-30,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (31722-729-30),250,RC,31722-729-30,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (31722-730-30),250,RC,31722-730-30,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (31722-730-30),250,RC,31722-730-30,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 20 Tablet, Film Coated In 1 Bottle (31722-749-20)",250,RC,31722-749-20,NDC,,,facility,both,1,EA,,4.54,4.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 20 Tablet, Film Coated In 1 Bottle (31722-749-20)",250,RC,31722-749-20,NDC,,,facility,both,1,EA,,4.82,4.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (31722-820-30),250,RC,31722-820-30,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (31722-820-30),250,RC,31722-820-30,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Entecavir: 30 Tablet In 1 Bottle (31722-833-30),250,RC,31722-833-30,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 1 Bottle In 1 Carton (31722-878-01)  / 100 Capsule In 1 Bottle,250,RC,31722-878-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (31722-952-01)",250,RC,31722-952-01,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 30 Tablet, Film Coated In 1 Bottle (33342-062-07)",250,RC,33342-062-07,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 30 Tablet, Film Coated In 1 Bottle (33342-062-07)",250,RC,33342-062-07,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (33342-063-10)",250,RC,33342-063-10,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (33342-063-10)",250,RC,33342-063-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-727-30)",250,RC,31722-727-30,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ammonia Inhalants: 12 AMPULE in 1 CARTON (39822-9900-2)  / .3 mL in 1 AMPULE,250,RC,39822-9900-2,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmedetomidine Hydrochloride: 25 Vial In 1 Carton (42023-146-25)  / 2 Ml In 1 Vial,250,RC,42023-146-25,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ethacrynate Sodium: 1 Vial In 1 Carton (42023-157-01)  / 50 Ml In 1 Vial,250,RC,42023-157-01,NDC,,,facility,both,1,EA,,1006.46,1006.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adrenalin: 25 Vial In 1 Carton (42023-159-25)  / 1 Ml In 1 Vial (42023-159-01),250,RC,42023-159-25,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42023-164-01,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adrenalin: 1 Vial In 1 Carton (42023-168-01)  / 30 Ml In 1 Vial,250,RC,42023-168-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42023-179-01,NDC,,,facility,both,1,EA,,7.19,7.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42023-216-01,NDC,,,facility,both,1,EA,,7.57,7.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ephedrine Sulfate: 25 Vial In 1 Carton (42023-216-25)  / 1 Ml In 1 Vial (42023-216-01),250,RC,42023-216-25,NDC,,,facility,both,1,EA,,15.28,15.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42023-230-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (39822-1100-1)  / 10 Ml In 1 Vial, Multi-Dose",250,RC,39822-1100-1,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amphotericin B: 10 Ml In 1 Vial (39822-1055-5),250,RC,39822-1055-5,NDC,,,facility,both,1,EA,,68.23,68.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",250,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",250,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 40 Bag In 1 Carton (36000-306-60)  / 100 Ml In 1 Bag,250,RC,36000-306-60,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04)  / 5.8 G In 1 Packet,250,RC,37000-024-04,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04)  / 5.8 G In 1 Packet,250,RC,37000-024-04,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metamucil Therapy For Regularity: 5.8 G In 1 Packet (37000-024-10),250,RC,37000-024-10,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,38779-1284-5,NDC,,,facility,both,1,EA,,45.71,45.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (39328-024-30)  / 30 G In 1 Tube,250,RC,39328-024-30,NDC,,,facility,both,1,EA,,38.41,38.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (39328-024-30)  / 30 G In 1 Tube,250,RC,39328-024-30,NDC,,,facility,both,1,EA,,38.32,38.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1)  / 5 Ml In 1 Vial, Glass",250,RC,39822-0190-1,NDC,,,facility,both,1,EA,,35.25,35.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 10 Vial In 1 Carton (39822-1000-1)  / 10 Ml In 1 Vial,250,RC,39822-1000-1,NDC,,,facility,both,1,EA,,5.88,5.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose",250,RC,36000-283-25,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42023-237-01,NDC,,,facility,both,1,EA,,3.47,3.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-727-30)",250,RC,31722-727-30,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-700-90)",250,RC,31722-700-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (27241-098-03)",250,RC,27241-098-03,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,27241-134-21,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,27241-134-21,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Pouch In 1 Carton (27241-139-09)  / 1 Bottle In 1 Pouch / 60 Ml In 1 Bottle,250,RC,27241-139-09,NDC,,,facility,both,1,EA,,5.75,5.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valganciclovir Hydrochloride: 1 Pouch In 1 Carton (27241-159-19)  / 1 Bottle In 1 Pouch / 100 Ml In 1 Bottle,250,RC,27241-159-19,NDC,,,facility,both,1,EA,,8.97,8.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Tablet In 1 Bottle (27241-162-01),250,RC,27241-162-01,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 30 Ml In 1 Bottle, Unit-Dose (27808-002-01)",250,RC,27808-002-01,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (27808-155-01)",250,RC,27808-155-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (27808-155-01)",250,RC,27808-155-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colesevelam Hydrochloride: 180 Tablet In 1 Bottle (27808-190-01),250,RC,27808-190-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline: 50 Capsule In 1 Bottle (27808-233-01),250,RC,27808-233-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline: 50 Capsule In 1 Bottle (27808-233-01),250,RC,27808-233-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 200 Capsule In 1 Bottle (29033-026-02),250,RC,29033-026-02,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 200 Capsule In 1 Bottle (29033-026-02),250,RC,29033-026-02,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metformin Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (29033-056-01)",250,RC,29033-056-01,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluoxetine: 120 Ml In 1 Bottle, Plastic (29033-503-31)",250,RC,29033-503-31,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamotrigine: 60 Tablet In 1 Bottle, Plastic (29300-113-16)",250,RC,29300-113-16,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamotrigine: 60 Tablet In 1 Bottle, Plastic (29300-113-16)",250,RC,29300-113-16,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Entacapone: 100 Tablet In 1 Bottle (27241-049-10),250,RC,27241-049-10,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Entacapone: 100 Tablet In 1 Bottle (27241-049-10),250,RC,27241-049-10,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 25 Vial In 1 Carton (25021-608-20)  / 20 Ml In 1 Vial,250,RC,25021-608-20,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glydo: 10 Syringe In 1 Carton (25021-673-76)  / 6 Ml In 1 Syringe,250,RC,25021-673-76,NDC,,,facility,both,1,EA,,6.53,6.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glydo: 10 Syringe In 1 Carton (25021-673-76)  / 6 Ml In 1 Syringe,250,RC,25021-673-76,NDC,,,facility,both,1,EA,,6.46,6.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glydo: 10 Syringe In 1 Carton (25021-673-77)  / 11 Ml In 1 Syringe,250,RC,25021-673-77,NDC,,,facility,both,1,EA,,8.34,8.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glydo: 10 Syringe In 1 Carton (25021-673-77)  / 11 Ml In 1 Syringe,250,RC,25021-673-77,NDC,,,facility,both,1,EA,,7.38,7.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketamine Hydrochloride: 10 Vial In 1 Carton (25021-684-05)  / 5 Ml In 1 Vial,250,RC,25021-684-05,NDC,,,facility,both,1,EA,,12.48,12.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pantoprazole Sodium: 10 Vial In 1 Carton (25021-751-10)  / 10 Ml In 1 Vial,250,RC,25021-751-10,NDC,,,facility,both,1,EA,,2.66,2.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Edisylate: 10 Vial In 1 Carton (25021-790-02)  / 2 Ml In 1 Vial,250,RC,25021-790-02,NDC,,,facility,both,1,EA,,3,3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Edisylate: 10 Vial In 1 Carton (25021-790-02)  / 2 Ml In 1 Vial,250,RC,25021-790-02,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 10 Vial, Glass In 1 Carton (25021-791-20)  / 20 Ml In 1 Vial, Glass",250,RC,25021-791-20,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-126-13)",250,RC,29300-126-13,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (31722-173-01),250,RC,31722-173-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)",250,RC,31722-186-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)",250,RC,31722-186-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial,250,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial,250,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Tablet In 1 Bottle (31722-138-01),250,RC,31722-138-01,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (31722-530-01),250,RC,31722-530-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (31722-532-01),250,RC,31722-532-01,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Maraviroc: 60 Tablet, Film Coated In 1 Bottle (31722-580-60)",250,RC,31722-580-60,NDC,,,facility,both,1,EA,,16.31,16.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-630-31),250,RC,31722-630-31,NDC,,,facility,both,1,EA,,4.66,4.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-632-31),250,RC,31722-632-31,NDC,,,facility,both,1,EA,,4.7,4.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-700-90)",250,RC,31722-700-90,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (31722-530-01),250,RC,31722-530-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Tablet In 1 Bottle (31722-138-01),250,RC,31722-138-01,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (31722-103-30)",250,RC,31722-103-30,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-131-01)",250,RC,29300-131-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-135-01)",250,RC,29300-135-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)",250,RC,29300-140-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)",250,RC,29300-140-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metronidazole: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-227-01)",250,RC,29300-227-01,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metronidazole: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-227-01)",250,RC,29300-227-01,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-355-01)",250,RC,29300-355-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-355-01)",250,RC,29300-355-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 60 Tablet In 1 Bottle (29300-359-16),250,RC,29300-359-16,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 60 Tablet In 1 Bottle (29300-359-16),250,RC,29300-359-16,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-413-01)",250,RC,29300-413-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-413-01)",250,RC,29300-413-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Droxidopa: 90 Capsule In 1 Bottle (31722-014-90),250,RC,31722-014-90,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Droxidopa: 90 Capsule In 1 Bottle (31722-014-90),250,RC,31722-014-90,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (31722-053-60)",250,RC,31722-053-60,NDC,,,facility,both,1,EA,,8.55,8.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (31722-103-30)",250,RC,31722-103-30,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-126-13)",250,RC,29300-126-13,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ephedrine Sulfate: 10 Ml In 1 Vial, Single-Dose (42023-243-01)",250,RC,42023-243-01,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43528-003-01,NDC,,,facility,both,1,EA,,256.62,256.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-269-10)",250,RC,43547-269-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-269-10)",250,RC,43547-269-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-273-10)",250,RC,43547-273-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 90 Tablet, Film Coated In 1 Bottle, Plastic (43547-276-09)",250,RC,43547-276-09,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 90 Tablet, Film Coated In 1 Bottle, Plastic (43547-276-09)",250,RC,43547-276-09,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 100 Tablet, Film Coated, Extended Release In 1 Bottle (43547-289-10)",250,RC,43547-289-10,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Tablet In 1 Bottle (43547-352-10),250,RC,43547-352-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Tablet In 1 Bottle (43547-354-10),250,RC,43547-354-10,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valsartan: 30 Tablet In 1 Bottle (43547-367-03),250,RC,43547-367-03,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valsartan: 30 Tablet In 1 Bottle (43547-367-03),250,RC,43547-367-03,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (43547-374-03),250,RC,43547-374-03,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (43547-374-03),250,RC,43547-374-03,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-399-10)",250,RC,43547-399-10,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-399-10)",250,RC,43547-399-10,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 100 Tablet, Film Coated, Extended Release In 1 Bottle (43547-289-10)",250,RC,43547-289-10,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flucytosine: 100 Capsule In 1 Bottle (43386-771-01),250,RC,43386-771-01,NDC,,,facility,both,1,EA,,14.04,14.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flucytosine: 100 Capsule In 1 Bottle (43386-770-01),250,RC,43386-770-01,NDC,,,facility,both,1,EA,,28.64,28.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 473 Ml In 1 Bottle, Plastic (42858-304-16)",250,RC,42858-304-16,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 473 Ml In 1 Bottle, Plastic (42858-304-16)",250,RC,42858-304-16,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (42858-502-03),250,RC,42858-502-03,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dronabinol: 60 Capsule In 1 Bottle (42858-867-06),250,RC,42858-867-06,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43066-008-01,NDC,,,facility,both,1,EA,,5.83,5.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cardene Iv: 10 Bag In 1 Carton (43066-016-10)  / 200 Ml In 1 Bag,250,RC,43066-016-10,NDC,,,facility,both,1,EA,,111.4,111.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43066-090-01,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nexterone: 100 Ml In 1 Bag (43066-150-10),250,RC,43066-150-10,NDC,,,facility,both,1,EA,,8.91,8.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nexterone: 200 Ml In 1 Bag (43066-360-20),250,RC,43066-360-20,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43066-997-01,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (43066-997-10)  / 4 Ml In 1 Vial, Single-Dose (43066-997-01)",250,RC,43066-997-10,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gavilyte-N: 438.4 G In 1 Bottle (43386-050-19),250,RC,43386-050-19,NDC,,,facility,both,1,EA,,18.04,18.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Misoprostol: 120 Tablet In 1 Bottle (43386-160-12),250,RC,43386-160-12,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43386-194-90,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25)  / 25 Tablet In 1 Blister Pack,250,RC,42858-302-25,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetrabenazine: 112 Tablet In 1 Bottle (43598-394-67),250,RC,43598-394-67,NDC,,,facility,both,1,EA,,4.45,4.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-405-11,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-436-35,NDC,,,facility,both,1,EA,,38.22,38.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-446-71,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-446-71,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-447-71,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-448-71,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-448-71,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-479-01,NDC,,,facility,both,1,EA,,17.09,17.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 30 Capsule, Delayed Release In 1 Bottle (43598-510-30)",250,RC,43598-510-30,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 30 Capsule, Delayed Release In 1 Bottle (43598-510-30)",250,RC,43598-510-30,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-447-71,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 30 Tablet In 1 Bottle (43598-372-30),250,RC,43598-372-30,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 30 Tablet In 1 Bottle (43598-372-30),250,RC,43598-372-30,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10),250,RC,43547-688-10,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10),250,RC,43547-688-10,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 100 Tablet In 1 Bottle (43547-689-10),250,RC,43547-689-10,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 100 Tablet In 1 Bottle (43547-689-10),250,RC,43547-689-10,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43598-036-01)",250,RC,43598-036-01,NDC,,,facility,both,1,EA,,6.69,6.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (43598-051-11)  / 2 Ml In 1 Vial, Multi-Dose",250,RC,43598-051-11,NDC,,,facility,both,1,EA,,1838.15,1838.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-106-11,NDC,,,facility,both,1,EA,,17.41,17.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ssd Cream: 400 G In 1 Jar (43598-210-40),250,RC,43598-210-40,NDC,,,facility,both,1,EA,,68.01,68.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ssd Cream: 50 G In 1 Jar (43598-210-55),250,RC,43598-210-55,NDC,,,facility,both,1,EA,,12.59,12.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin And Dexamethasone: 1 Bottle, Dropper In 1 Carton (43598-326-75)  / 7.5 Ml In 1 Bottle, Dropper",250,RC,43598-326-75,NDC,,,facility,both,1,EA,,166.81,166.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25)  / 25 Tablet In 1 Blister Pack,250,RC,42858-302-25,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)",250,RC,42858-302-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valsartan: 90 Tablet In 1 Bottle (42291-857-90),250,RC,42291-857-90,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (42291-923-01),250,RC,42291-923-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (42291-923-01),250,RC,42291-923-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42292-038-01,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42292-038-01,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42494-416-01,NDC,,,facility,both,1,EA,,31.52,31.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valsartan: 90 Tablet In 1 Bottle (42291-857-90),250,RC,42291-857-90,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dorzolamide Hydrochloride Ophthalmic Solution: 1 Bottle In 1 Carton (42571-141-26)  / 10 Ml In 1 Bottle,250,RC,42571-141-26,NDC,,,facility,both,1,EA,,24.31,24.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dorzolamide Hydrochloride Ophthalmic Solution: 1 Bottle In 1 Carton (42571-141-26)  / 10 Ml In 1 Bottle,250,RC,42571-141-26,NDC,,,facility,both,1,EA,,29.93,29.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dorzolamide Hydrochloride And Timolol Maleate Ophthalmic Solution: 1 Bottle In 1 Carton (42571-147-26)  / 10 Ml In 1 Bottle,250,RC,42571-147-26,NDC,,,facility,both,1,EA,,90.38,90.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methenamine Hippurate: 100 Tablet In 1 Bottle (42571-332-01),250,RC,42571-332-01,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methenamine Hippurate: 100 Tablet In 1 Bottle (42571-332-01),250,RC,42571-332-01,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 473 Ml In 1 Bottle (42571-357-07),250,RC,42571-357-07,NDC,,,facility,both,1,EA,,21.23,21.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rufinamide: 120 Tablet In 1 Bottle (42571-392-12),250,RC,42571-392-12,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irbesartan: 90 Tablet, Film Coated In 1 Bottle (42658-122-04)",250,RC,42658-122-04,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irbesartan: 90 Tablet, Film Coated In 1 Bottle (42658-122-04)",250,RC,42658-122-04,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 5 Ml In 1 Bottle (42571-137-25),250,RC,42571-137-25,NDC,,,facility,both,1,EA,,54.22,54.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42291-495-11,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42291-495-11,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Np Thyroid 15: 100 Tablet In 1 Bottle (42192-327-01),250,RC,42192-327-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Np Thyroid 15: 100 Tablet In 1 Bottle (42192-327-01),250,RC,42192-327-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Np Thyroid 30: 100 Tablet In 1 Bottle (42192-329-01),250,RC,42192-329-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),250,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),250,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)",250,RC,42192-608-06,NDC,,,facility,both,1,EA,,5.87,5.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)",250,RC,42192-608-06,NDC,,,facility,both,1,EA,,5.85,5.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 470 Ml In 1 Bottle (42192-608-16),250,RC,42192-608-16,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (42291-094-30)  / 30 Ml In 1 Bottle, Spray",250,RC,42291-094-30,NDC,,,facility,both,1,EA,,20.35,20.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (42291-094-30)  / 30 Ml In 1 Bottle, Spray",250,RC,42291-094-30,NDC,,,facility,both,1,EA,,20.35,20.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (42291-399-30)  / 30 G In 1 Tube,250,RC,42291-399-30,NDC,,,facility,both,1,EA,,21.17,21.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (42291-399-30)  / 30 G In 1 Tube,250,RC,42291-399-30,NDC,,,facility,both,1,EA,,21.17,21.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dofetilide: 60 Capsule In 1 Bottle, Plastic (42291-412-60)",250,RC,42291-412-60,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 90 Tablet, Coated In 1 Bottle (42291-454-90)",250,RC,42291-454-90,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (42291-459-30)",250,RC,42291-459-30,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (42291-459-30)",250,RC,42291-459-30,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (42291-472-01),250,RC,42291-472-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42291-477-11,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42291-477-11,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (42702-102-10)  / 10 Ml In 1 Bottle, Dropper",250,RC,42702-102-10,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (42702-102-10)  / 10 Ml In 1 Bottle, Dropper",250,RC,42702-102-10,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entecavir: 30 Tablet In 1 Bottle, Plastic (42806-659-30)",250,RC,42806-659-30,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 100 Capsule In 1 Bottle (42806-714-01),250,RC,42806-714-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 100 Capsule In 1 Bottle (42806-714-01),250,RC,42806-714-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfadiazine: 60 Tablet In 1 Bottle (42806-757-60),250,RC,42806-757-60,NDC,,,facility,both,1,EA,,18.8,18.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-001-01)",250,RC,42858-001-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-001-01)",250,RC,42858-001-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10)  / 10 Tablet In 1 Blister Pack,250,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10)  / 10 Tablet In 1 Blister Pack,250,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-002-01)",250,RC,42858-002-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-002-10)  / 10 Tablet In 1 Blister Pack,250,RC,42858-002-10,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-002-10)  / 10 Tablet In 1 Blister Pack,250,RC,42858-002-10,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-003-01)",250,RC,42858-003-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine 5%: 30 POUCH in 1 PACKAGE (42858-118-30)  / 1 PATCH in 1 POUCH,250,RC,42858-118-30,NDC,,,facility,both,1,EA,,3.93,3.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25)  / 25 Tablet In 1 Blister Pack,250,RC,42858-301-25,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25)  / 25 Tablet In 1 Blister Pack,250,RC,42858-301-25,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)",250,RC,42858-302-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entecavir: 30 Tablet In 1 Bottle, Plastic (42806-658-30)",250,RC,42806-658-30,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Leucovorin Calcium: 30 Tablet In 1 Bottle (42806-358-30),250,RC,42806-358-30,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flucytosine: 30 Capsule In 1 Bottle (42794-009-08),250,RC,42794-009-08,NDC,,,facility,both,1,EA,,54.22,54.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Liothyronine Sodium: 90 Tablet In 1 Bottle (42794-019-12),250,RC,42794-019-12,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Liothyronine Sodium: 90 Tablet In 1 Bottle (42794-019-12),250,RC,42794-019-12,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ivermectin: 2 Blister Pack In 1 Carton (42799-806-01)  / 10 Tablet In 1 Blister Pack,250,RC,42799-806-01,NDC,,,facility,both,1,EA,,6.81,6.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Estradiol: 100 Tablet In 1 Bottle (42806-087-01),250,RC,42806-087-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Estradiol: 100 Tablet In 1 Bottle (42806-087-01),250,RC,42806-087-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Estradiol: 100 Tablet In 1 Bottle (42806-089-01),250,RC,42806-089-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ethambutol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42806-102-01)",250,RC,42806-102-01,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42806-266-98,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,42806-266-98,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)",250,RC,42806-339-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)",250,RC,42806-339-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (42806-423-01)",250,RC,42806-423-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Thiamine Hydrochloride: 25 Vial In 1 Carton (25021-500-02)  / 2 Ml In 1 Vial,250,RC,25021-500-02,NDC,,,facility,both,1,EA,,3.19,3.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 10 Bag In 1 Carton (25021-418-82)  / 100 Ml In 1 Bag,250,RC,25021-418-82,NDC,,,facility,both,1,EA,,11.57,11.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Itraconazole: 30 Capsule, Coated Pellets In 1 Bottle (16714-743-02)",250,RC,16714-743-02,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atomoxetine: 30 Capsule In 1 Bottle (16714-755-01),250,RC,16714-755-01,NDC,,,facility,both,1,EA,,3.37,3.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atomoxetine: 30 Capsule In 1 Bottle (16714-755-01),250,RC,16714-755-01,NDC,,,facility,both,1,EA,,3.31,3.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine: 30 Tablet In 1 Bottle (16714-795-01),250,RC,16714-795-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine: 30 Tablet In 1 Bottle (16714-795-01),250,RC,16714-795-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine: 100 Tablet In 1 Bottle (16714-795-02),250,RC,16714-795-02,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine: 100 Tablet In 1 Bottle (16714-795-02),250,RC,16714-795-02,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-718-01)",250,RC,16714-718-01,NDC,,,facility,both,1,EA,,3.3,3.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sumatriptan: 1 Blister Pack In 1 Carton (16714-796-01)  / 9 Tablet In 1 Blister Pack,250,RC,16714-796-01,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01)  / 9 Tablet In 1 Blister Pack,250,RC,16714-797-01,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01)  / 9 Tablet In 1 Blister Pack,250,RC,16714-797-01,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01),250,RC,16714-813-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01),250,RC,16714-813-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 90 Tablet In 1 Bottle (16714-813-02),250,RC,16714-813-02,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 90 Tablet In 1 Bottle (16714-813-02),250,RC,16714-813-02,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sumatriptan: 1 Blister Pack In 1 Carton (16714-796-01)  / 9 Tablet In 1 Blister Pack,250,RC,16714-796-01,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-717-01)",250,RC,16714-717-01,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-717-01)",250,RC,16714-717-01,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 30 Tablet, Film Coated In 1 Bottle (16714-682-01)",250,RC,16714-682-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-682-02)",250,RC,16714-682-02,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-682-02)",250,RC,16714-682-02,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-683-02)",250,RC,16714-683-02,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-683-02)",250,RC,16714-683-02,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-691-01),250,RC,16714-691-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-693-01),250,RC,16714-693-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-693-01),250,RC,16714-693-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-694-01),250,RC,16714-694-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-694-01),250,RC,16714-694-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 1 Bottle In 1 Carton (16714-696-01)  / 35 Ml In 1 Bottle,250,RC,16714-696-01,NDC,,,facility,both,1,EA,,7.17,7.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 1 Bottle In 1 Carton (16714-696-01)  / 35 Ml In 1 Bottle,250,RC,16714-696-01,NDC,,,facility,both,1,EA,,6.8,6.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-697-03)",250,RC,16714-697-03,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-697-03)",250,RC,16714-697-03,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-698-03)",250,RC,16714-698-03,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-698-03)",250,RC,16714-698-03,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (16714-814-01)",250,RC,16714-814-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (16714-814-01)",250,RC,16714-814-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (16714-820-01)",250,RC,16714-820-01,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bicalutamide: 30 Tablet In 1 Bottle (16729-023-10),250,RC,16729-023-10,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-136-00)",250,RC,16729-136-00,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-136-00)",250,RC,16729-136-00,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)",250,RC,16729-136-16,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)",250,RC,16729-136-16,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-137-00)",250,RC,16729-137-00,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-137-00)",250,RC,16729-137-00,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Tablet, Film Coated In 1 Bottle (16729-145-01)",250,RC,16729-145-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrochlorothiazide: 100 Tablet In 1 Bottle (16729-184-01),250,RC,16729-184-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (16729-200-01),250,RC,16729-200-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (16729-200-01),250,RC,16729-200-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16729-239-30,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16729-239-30,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)",250,RC,16714-990-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)",250,RC,16714-990-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clomipramine Hydrochloride: 30 Capsule In 1 Bottle (16714-850-01),250,RC,16714-850-01,NDC,,,facility,both,1,EA,,6.02,6.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (16714-867-01)",250,RC,16714-867-01,NDC,,,facility,both,1,EA,,5.61,5.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (16714-868-01)",250,RC,16714-868-01,NDC,,,facility,both,1,EA,,5.6,5.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 100 TABLET in 1 BOTTLE (16714-883-01) ,250,RC,16714-883-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobazam: 100 Tablet In 1 Bottle (16714-887-01),250,RC,16714-887-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobazam: 100 Tablet In 1 Bottle (16714-887-01),250,RC,16714-887-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Permethrin: 1 Tube In 1 Container (16714-897-01)  / 60 G In 1 Tube,250,RC,16714-897-01,NDC,,,facility,both,1,EA,,29.13,29.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (16714-950-01)",250,RC,16714-950-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (16714-950-01)",250,RC,16714-950-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (16714-980-02)",250,RC,16714-980-02,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (16714-980-02)",250,RC,16714-980-02,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-988-01)",250,RC,16714-988-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-988-01)",250,RC,16714-988-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)",250,RC,16714-989-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)",250,RC,16714-989-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (16714-820-01)",250,RC,16714-820-01,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 125 Ml In 1 Bottle (16714-294-02),250,RC,16714-294-02,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 125 Ml In 1 Bottle (16714-294-02),250,RC,16714-294-02,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (16714-296-01)",250,RC,16714-296-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (16714-296-01)",250,RC,16714-296-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Capsule In 1 Bottle (16714-298-01),250,RC,16714-298-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Capsule In 1 Bottle (16714-299-03),250,RC,16714-299-03,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-257-01)",250,RC,16714-257-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Capsule In 1 Bottle (16714-299-03),250,RC,16714-299-03,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-301-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (16714-354-01)",250,RC,16714-354-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 473 Ml In 1 Bottle, Plastic (16714-358-01)",250,RC,16714-358-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01),250,RC,16714-388-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01),250,RC,16714-388-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 100 Capsule In 1 Bottle (16714-388-02),250,RC,16714-388-02,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-257-01)",250,RC,16714-257-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose",250,RC,16714-248-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-141-01),250,RC,16714-141-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-141-01),250,RC,16714-141-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01),250,RC,16714-142-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01),250,RC,16714-142-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-143-01),250,RC,16714-143-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-144-01),250,RC,16714-144-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 60 Tablet In 1 Bottle (16714-197-01),250,RC,16714-197-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 60 Tablet In 1 Bottle (16714-197-01),250,RC,16714-197-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-200-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (16714-234-01)",250,RC,16714-234-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (16714-235-01)",250,RC,16714-235-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-245-01,NDC,,,facility,both,1,EA,,7.41,7.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 100 Capsule In 1 Bottle (16714-388-02),250,RC,16714-388-02,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 75 Ml In 1 Bottle (16714-390-01),250,RC,16714-390-01,NDC,,,facility,both,1,EA,,5.61,5.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02)  / 60 Ml In 1 Bottle, Plastic",250,RC,16714-601-02,NDC,,,facility,both,1,EA,,4.51,4.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-611-04)",250,RC,16714-611-04,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-611-04)",250,RC,16714-611-04,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-612-04)",250,RC,16714-612-04,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-612-04)",250,RC,16714-612-04,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-613-04)",250,RC,16714-613-04,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-613-04)",250,RC,16714-613-04,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)",250,RC,16714-621-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)",250,RC,16714-621-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Capsule In 1 Bottle (16714-661-01),250,RC,16714-661-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Capsule In 1 Bottle (16714-661-01),250,RC,16714-661-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 500 Capsule In 1 Bottle (16714-661-02),250,RC,16714-661-02,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 500 Capsule In 1 Bottle (16714-662-02),250,RC,16714-662-02,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 500 Capsule In 1 Bottle (16714-662-02),250,RC,16714-662-02,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Capsule In 1 Bottle (16714-663-01),250,RC,16714-663-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Capsule In 1 Bottle (16714-663-01),250,RC,16714-663-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02)  / 60 Ml In 1 Bottle, Plastic",250,RC,16714-601-02,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmedetomidine: 25 Vial In 1 Carton (16729-239-93)  / 2 Ml In 1 Vial (16729-239-30),250,RC,16729-239-93,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 100 Tablet In 1 Bottle (16714-590-01),250,RC,16714-590-01,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (16714-394-01)",250,RC,16714-394-01,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (16714-395-01)",250,RC,16714-395-01,NDC,,,facility,both,1,EA,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (16714-395-01)",250,RC,16714-395-01,NDC,,,facility,both,1,EA,,8.4,8.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefuroxime Axetil: 20 Tablet In 1 Bottle (16714-400-01),250,RC,16714-400-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (16714-439-01),250,RC,16714-439-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (16714-439-01),250,RC,16714-439-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (16714-444-01),250,RC,16714-444-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Tablet, Film Coated In 1 Bottle (16714-452-01)",250,RC,16714-452-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (16714-477-01)",250,RC,16714-477-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (16714-477-01)",250,RC,16714-477-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clindamycin Palmitate Hydrochloride (Pediatric): 1 Bottle, Plastic In 1 Carton (16714-483-02)  / 100 Ml In 1 Bottle, Plastic",250,RC,16714-483-02,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pravastatin Sodium: 90 Tablet In 1 Bottle (16714-559-01),250,RC,16714-559-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pravastatin Sodium: 90 Tablet In 1 Bottle (16714-559-01),250,RC,16714-559-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (16714-576-02),250,RC,16714-576-02,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (16714-576-02),250,RC,16714-576-02,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 100 Tablet In 1 Bottle (16714-590-01),250,RC,16714-590-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle, Plastic (24979-231-01)",250,RC,24979-231-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mephyton: 1 BOTTLE in 1 CARTON (25010-405-15)  / 100 TABLET in 1 BOTTLE,250,RC,25010-405-15,NDC,,,facility,both,1,EA,,21.51,21.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (25021-052-05)  / 5 Ml In 1 Vial,250,RC,25021-052-05,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 25 VIAL in 1 CARTON (25021-101-67)  / 3 mL in 1 VIAL,250,RC,25021-101-67,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride (Xl): 90 Tablet, Extended Release In 1 Bottle, Plastic (24979-101-07)",250,RC,24979-101-07,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 25 VIAL in 1 CARTON (25021-101-67)  / 3 mL in 1 VIAL,250,RC,25021-101-67,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 25 VIAL in 1 CARTON (25021-106-67)  / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL",250,RC,25021-106-67,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 25 Vial In 1 Carton (25021-107-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,25021-107-20,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 24 Pouch In 1 Carton (25021-114-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,250,RC,25021-114-87,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 10 Vial In 1 Carton (25021-121-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,25021-121-20,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 Pouch In 1 Carton (25021-131-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,25021-131-82,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride (Xl): 90 Tablet, Extended Release In 1 Bottle, Plastic (24979-101-07)",250,RC,24979-101-07,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Tablet, Extended Release In 1 Bottle (24979-010-01)",250,RC,24979-010-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gentamicin Sulfate: 1 Bottle, Dropper In 1 Carton (24208-580-60)  / 5 Ml In 1 Bottle, Dropper",250,RC,24208-580-60,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tropicamide: 1 Bottle, Dropper In 1 Carton (24208-585-59)  / 2 Ml In 1 Bottle, Dropper",250,RC,24208-585-59,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neomycin And Polymyxin B Sulfates And Hydrocortisone: 1 Bottle, Dropper In 1 Carton (24208-635-62)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-635-62,NDC,,,facility,both,1,EA,,114.46,114.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02)  / 5 Ml In 1 Bottle, Dropper",250,RC,24208-720-02,NDC,,,facility,both,1,EA,,77.43,77.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02)  / 5 Ml In 1 Bottle, Dropper",250,RC,24208-720-02,NDC,,,facility,both,1,EA,,77.49,77.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Proparacaine Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-730-06)  / 15 Ml In 1 Bottle, Dropper",250,RC,24208-730-06,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclopentolate Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-735-01)  / 2 Ml In 1 Bottle, Dropper",250,RC,24208-735-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neomycin And Polymyxin B Sulfates And Bacitracin Zinc: 1 Tube In 1 Carton (24208-780-55)  / 3.5 G In 1 Tube,250,RC,24208-780-55,NDC,,,facility,both,1,EA,,81.78,81.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neomycin And Polymyxin B Sulfates, Bacitracin Zinc And Hydrocortisone: 1 Tube In 1 Carton (24208-785-55)  / 3.5 G In 1 Tube",250,RC,24208-785-55,NDC,,,facility,both,1,EA,,75.19,75.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neomycin And Polymyxin B Sulfates And Gramicidin: 1 Bottle, Dropper In 1 Carton (24208-790-62)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-790-62,NDC,,,facility,both,1,EA,,68.66,68.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neomycin And Polymyxin B Sulfates And Gramicidin: 1 Bottle, Dropper In 1 Carton (24208-790-62)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-790-62,NDC,,,facility,both,1,EA,,68.48,68.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythromycin: 50 Tube In 1 Box (24208-910-19)  / 1 G In 1 Tube,250,RC,24208-910-19,NDC,,,facility,both,1,EA,,11.11,11.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythromycin: 1 Tube In 1 Carton (24208-910-55)  / 3.5 G In 1 Tube,250,RC,24208-910-55,NDC,,,facility,both,1,EA,,21.98,21.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythromycin: 1 Tube In 1 Carton (24208-910-55)  / 3.5 G In 1 Tube,250,RC,24208-910-55,NDC,,,facility,both,1,EA,,21.92,21.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
E.E.S: 200 Ml In 1 Bottle (24338-136-10),250,RC,24338-136-10,NDC,,,facility,both,1,EA,,38.81,38.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,24338-230-05,NDC,,,facility,both,1,EA,,92.12,92.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,24338-260-10,NDC,,,facility,both,1,EA,,192.52,192.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,24357-701-05,NDC,,,facility,both,1,EA,,5.3,5.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,24357-701-05,NDC,,,facility,both,1,EA,,5.3,5.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Quillivant Xr: 1 Bottle In 1 Carton (24478-321-02)  / 60 Ml In 1 Bottle,250,RC,24478-321-02,NDC,,,facility,both,1,EA,,79.17,79.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (24979-004-07)",250,RC,24979-004-07,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Tablet, Extended Release In 1 Bottle (24979-010-01)",250,RC,24979-010-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc And Polymyxin B Sulfate: 1 Tube In 1 Carton (24208-555-55)  / 3.5 G In 1 Tube,250,RC,24208-555-55,NDC,,,facility,both,1,EA,,10.7,10.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levofloxacin: 24 Pouch In 1 Carton (25021-132-81)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag,250,RC,25021-132-81,NDC,,,facility,both,1,EA,,12.65,12.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Carton (25021-311-04)  / 4 Ml In 1 Vial,250,RC,25021-311-04,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diltiazem Hydrochloride: 10 Vial In 1 Carton (25021-319-25)  / 25 Ml In 1 Vial,250,RC,25021-319-25,NDC,,,facility,both,1,EA,,14.8,14.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial,250,RC,25021-321-04,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Carton (25021-400-30)  / 30 Ml In 1 Vial,250,RC,25021-400-30,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Carton (25021-402-01)  / 1 Ml In 1 Vial,250,RC,25021-402-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Carton (25021-402-01)  / 1 Ml In 1 Vial,250,RC,25021-402-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Eptifibatide: 1 Vial In 1 Carton (25021-408-51)  / 100 Ml In 1 Vial,250,RC,25021-408-51,NDC,,,facility,both,1,EA,,26.9,26.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Esmolol Hydrochloride: 10 Bag In 1 Carton (25021-308-84)  / 250 Ml In 1 Bag,250,RC,25021-308-84,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-20)  / 18 Ml In 1 Vial,250,RC,25021-305-20,NDC,,,facility,both,1,EA,,53.31,53.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levofloxacin: 24 Pouch In 1 Carton (25021-132-83)  / 1 Bag In 1 Pouch / 150 Ml In 1 Bag,250,RC,25021-132-83,NDC,,,facility,both,1,EA,,6.07,6.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Carton (25021-136-10)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,25021-136-10,NDC,,,facility,both,1,EA,,3.95,3.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (25021-142-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,25021-142-20,NDC,,,facility,both,1,EA,,9.95,9.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Pouch In 1 Carton (25021-184-67)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,250,RC,25021-184-67,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Pouch In 1 Carton (25021-184-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,25021-184-82,NDC,,,facility,both,1,EA,,7.26,7.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Pouch In 1 Carton (25021-184-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,250,RC,25021-184-87,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Micafungin: 1 Vial In 1 Carton (25021-191-10)  / 5 Ml In 1 Vial,250,RC,25021-191-10,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,250,RC,25021-192-87,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc And Polymyxin B Sulfate: 1 Tube In 1 Carton (24208-555-55)  / 3.5 G In 1 Tube,250,RC,24208-555-55,NDC,,,facility,both,1,EA,,10.71,10.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (24208-486-10)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-486-10,NDC,,,facility,both,1,EA,,41.61,41.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (17478-201-15)  / 15 Ml In 1 Bottle, Dropper",250,RC,17478-201-15,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine: 1 BOTTLE, DROPPER in 1 CARTON (17478-215-02)  / 2 mL in 1 BOTTLE, DROPPER",250,RC,17478-215-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 72 Cup, Unit-Dose In 1 Box, Unit-Dose (17856-1045-1)  / 5 Ml In 1 Cup, Unit-Dose (17856-1045-2)",250,RC,17856-1045-1,NDC,,,facility,both,1,EA,,8.32,8.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,18657-117-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,18657-117-02,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tropicamide: 1 BOTTLE, DROPPER in 1 CARTON (17478-101-12)  / 15 mL in 1 BOTTLE, DROPPER",250,RC,17478-101-12,NDC,,,facility,both,1,EA,,13.32,13.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,19515-810-41,NDC,,,facility,both,1,EA,,28.52,28.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,19515-904-41,NDC,,,facility,both,1,EA,,26.28,26.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (21922-009-09)  / 100 G In 1 Tube,250,RC,21922-009-09,NDC,,,facility,both,1,EA,,17.64,17.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (21922-009-09)  / 100 G In 1 Tube,250,RC,21922-009-09,NDC,,,facility,both,1,EA,,17.64,17.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 1 Tube In 1 Carton (21922-011-05)  / 30 G In 1 Tube,250,RC,21922-011-05,NDC,,,facility,both,1,EA,,86.55,86.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 30 Bag In 1 Case (17271-720-05)  / 250 Ml In 1 Bag,250,RC,17271-720-05,NDC,,,facility,both,1,EA,,5.85,5.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (16729-294-10)",250,RC,16729-294-10,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 1 Tube In 1 Carton (16729-422-10)  / 30 G In 1 Tube,250,RC,16729-422-10,NDC,,,facility,both,1,EA,,70.98,70.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 90 Tablet, Film Coated In 1 Bottle, Plastic (16729-440-15)",250,RC,16729-440-15,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 100 Tablet In 1 Bottle (16729-486-01),250,RC,16729-486-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 100 Tablet In 1 Bottle (16729-486-01),250,RC,16729-486-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"5 BLISTER PACK in 1 CARTON (16837-855-25)  / 5 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,16837-855-25,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Balmex Diaper Rash: 1 TUBE in 1 CARTON (16864-908-03)  / 56 g in 1 TUBE,250,RC,16864-0908-03,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Balmex Diaper Rash: 1 TUBE in 1 CARTON (16864-908-03)  / 56 g in 1 TUBE,250,RC,16864-0908-03,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dermoplast Pain Relieving: 78 G In 1 Can (16864-680-01),250,RC,16864-680-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dermoplast Pain Relieving: 85 G In 1 Can (16864-680-03),250,RC,16864-680-03,NDC,,,facility,both,1,EA,,10.62,10.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,17238-900-99,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (17271-701-05),250,RC,17271-701-05,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 500 Ml In 1 Bag (17271-701-06),250,RC,17271-701-06,NDC,,,facility,both,1,EA,,6.86,6.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 15 G In 1 Tube (21922-016-04)",250,RC,21922-016-04,NDC,,,facility,both,1,EA,,7.21,7.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 15 G In 1 Tube (21922-016-04)",250,RC,21922-016-04,NDC,,,facility,both,1,EA,,7.21,7.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-547-31,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-547-31,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-767-01),250,RC,23155-767-01,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-767-01),250,RC,23155-767-01,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxepin Hydrochloride: 100 Capsule In 1 Bottle (23155-795-01),250,RC,23155-795-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (23155-858-78)  / 10 Capsule In 1 Blister Pack,250,RC,23155-858-78,NDC,,,facility,both,1,EA,,4.03,4.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (23155-858-78)  / 10 Capsule In 1 Blister Pack,250,RC,23155-858-78,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,24201-100-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Latanoprost: 1 Bottle In 1 Carton (24208-463-25)  / 2.5 Ml In 1 Bottle,250,RC,24208-463-25,NDC,,,facility,both,1,EA,,17.67,17.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Latanoprost: 1 Bottle In 1 Carton (24208-463-25)  / 2.5 Ml In 1 Bottle,250,RC,24208-463-25,NDC,,,facility,both,1,EA,,17.92,17.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dorzolamide Hcl: 1 Bottle, Dropper In 1 Carton (24208-485-10)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-485-10,NDC,,,facility,both,1,EA,,21.73,21.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dorzolamide Hcl: 1 Bottle, Dropper In 1 Carton (24208-485-10)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-485-10,NDC,,,facility,both,1,EA,,20.74,20.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (24208-486-10)  / 10 Ml In 1 Bottle, Dropper",250,RC,24208-486-10,NDC,,,facility,both,1,EA,,41.42,41.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-512-11,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (21922-017-04)  / 15 G In 1 Tube,250,RC,21922-017-04,NDC,,,facility,both,1,EA,,7.24,7.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (21922-017-04)  / 15 G In 1 Tube,250,RC,21922-017-04,NDC,,,facility,both,1,EA,,7.11,7.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (21922-029-04)  / 15 G In 1 Tube,250,RC,21922-029-04,NDC,,,facility,both,1,EA,,44.56,44.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glyburide: 100 Tablet In 1 Bottle (23155-057-01),250,RC,23155-057-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methimazole: 100 Tablet In 1 Bottle (23155-070-01),250,RC,23155-070-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nifedipine: 100 Capsule In 1 Bottle (23155-194-01),250,RC,23155-194-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-240-31,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-294-31,NDC,,,facility,both,1,EA,,2.91,2.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 5 Ml In 1 Vial, Glass (23155-313-31)",250,RC,23155-313-31,NDC,,,facility,both,1,EA,,27.07,27.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-473-32,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,23155-473-32,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Verapamil Hydrochloride: 100 Tablet In 1 Bottle (23155-486-01),250,RC,23155-486-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-580-01,NDC,,,facility,both,1,EA,,9.16,9.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-580-01,NDC,,,facility,both,1,EA,,8.5,8.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-577-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xarelto: 60 Tablet, Film Coated In 1 Bottle (50458-577-60)",250,RC,50458-577-60,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-578-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-578-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xarelto: 10 Blister Pack In 1 Carton (50458-578-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-578-01)",250,RC,50458-578-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-579-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-579-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xarelto: 10 Blister Pack In 1 Carton (50458-579-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-579-01)",250,RC,50458-579-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-580-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xarelto: 10 Blister Pack In 1 Carton (50458-580-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-580-01)",250,RC,50458-580-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xarelto: 10 Blister Pack In 1 Carton (50458-580-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-580-01)",250,RC,50458-580-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 100 Blister Pack In 1 Carton (50474-570-09)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,50474-570-09,NDC,,,facility,both,1,EA,,43.29,43.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 1 Bottle In 1 Carton (50474-670-66)  / 60 Tablet, Film Coated In 1 Bottle",250,RC,50474-670-66,NDC,,,facility,both,1,EA,,44.34,44.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 100 Blister Pack In 1 Carton (50474-770-09)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,50474-770-09,NDC,,,facility,both,1,EA,,44.36,44.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 100 Blister Pack In 1 Carton (50474-770-09)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,50474-770-09,NDC,,,facility,both,1,EA,,43.32,43.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50458-580-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-772-11,NDC,,,facility,both,1,EA,,7.61,7.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-812-11,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levocarnitine: 9 BLISTER PACK in 1 CARTON (50383-172-90)  / 10 TABLET in 1 BLISTER PACK,250,RC,50383-172-90,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 1 BOTTLE, GLASS in 1 CARTON (50383-741-20)  / 20 mL in 1 BOTTLE, GLASS",250,RC,50383-741-20,NDC,,,facility,both,1,EA,,86.75,86.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adempas: 90 Tablet, Film Coated In 1 Bottle (50419-254-01)",250,RC,50419-254-01,NDC,,,facility,both,1,EA,,284.22,284.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-254-91)",250,RC,50419-254-91,NDC,,,facility,both,1,EA,,268.13,268.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01),250,RC,50419-423-01,NDC,,,facility,both,1,EA,,1781.59,1781.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cipro: 1 Kit In 1 Kit (50419-777-01)  *  100 Ml In 1 Bottle, Glass *  100 Ml In 1 Bottle, Plastic",250,RC,50419-777-01,NDC,,,facility,both,1,EA,,28.63,28.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Risperdal: 30 Ml In 1 Bottle (50458-305-03),250,RC,50458-305-03,NDC,,,facility,both,1,EA,,9.71,9.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 1 Bottle In 1 Carton (50474-770-66)  / 60 Tablet, Film Coated In 1 Bottle",250,RC,50474-770-66,NDC,,,facility,both,1,EA,,44.37,44.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-759-11,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 1 Bottle In 1 Carton (50474-770-66)  / 60 Tablet, Film Coated In 1 Bottle",250,RC,50474-770-66,NDC,,,facility,both,1,EA,,43.35,43.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-362-60)",250,RC,50742-362-60,NDC,,,facility,both,1,EA,,3.83,3.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-363-60)",250,RC,50742-363-60,NDC,,,facility,both,1,EA,,3.16,3.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50742-505-01,NDC,,,facility,both,1,EA,,17.17,17.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Scopolamine: 24 Pouch In 1 Carton (50742-505-24)  / 1 Patch, Extended Release In 1 Pouch",250,RC,50742-505-24,NDC,,,facility,both,1,EA,,9.09,9.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Scopolamine: 24 Pouch In 1 Carton (50742-505-24)  / 1 Patch, Extended Release In 1 Pouch",250,RC,50742-505-24,NDC,,,facility,both,1,EA,,9.79,9.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Norethindrone Acetate: 50 Tablet In 1 Bottle (50742-267-50),250,RC,50742-267-50,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (50742-615-01)",250,RC,50742-615-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-023-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-024-01,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-024-01,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-058-01,NDC,,,facility,both,1,EA,,2.76,2.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-058-01,NDC,,,facility,both,1,EA,,2.74,2.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (50742-615-01)",250,RC,50742-615-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (50742-261-03)",250,RC,50742-261-03,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (50742-261-03)",250,RC,50742-261-03,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30)  / 30 G In 1 Tube,250,RC,50484-010-30,NDC,,,facility,both,1,EA,,544.48,544.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30)  / 30 G In 1 Tube,250,RC,50484-010-30,NDC,,,facility,both,1,EA,,542.99,542.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tylenol Extra Strength: 10 Blister Pack In 1 Carton (50580-457-11)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,50580-457-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tylenol Extra Strength: 10 Blister Pack In 1 Carton (50580-457-11)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,50580-457-11,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,50580-458-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,50580-458-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"10 BLISTER PACK in 1 CARTON (50580-600-02)  / 10 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,50580-600-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rabavert: 1 Kit In 1 Carton (50632-010-01)  *  1 Ml In 1 Syringe (50632-011-01)  *  1 Ml In 1 Vial, Glass (50632-013-01)",250,RC,50632-010-01,NDC,,,facility,both,1,EA,,538.5,538.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50632-013-01,NDC,,,facility,both,1,EA,,538.5,538.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyanokit: 1 Vial, Glass In 1 Carton (50633-310-11)  / 250 Ml In 1 Vial, Glass",250,RC,50633-310-11,NDC,,,facility,both,1,EA,,1819.16,1819.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (50742-239-01),250,RC,50742-239-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-248-90)",250,RC,50742-248-90,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-251-90)",250,RC,50742-251-90,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Tablet, Extended Release In 1 Bottle (50742-261-01)",250,RC,50742-261-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-759-11,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-757-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-505-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-505-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-520-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-520-11,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-522-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-522-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-504-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-523-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-525-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-526-11,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-526-11,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-534-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-535-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-535-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-540-11,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-525-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-504-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-476-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-314-11,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-314-11,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-321-11,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-330-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-330-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fludrocortisone Acetate: 50 Blister Pack In 1 Box, Unit-Dose (50268-330-15)  / 1 Tablet In 1 Blister Pack (50268-330-11)",250,RC,50268-330-15,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fludrocortisone Acetate: 50 Blister Pack In 1 Box, Unit-Dose (50268-330-15)  / 1 Tablet In 1 Blister Pack (50268-330-11)",250,RC,50268-330-15,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-337-11,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-337-11,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-350-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-350-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-361-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-411-11,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-411-11,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone Acetate: 24 Suppository In 1 Carton (50268-411-24),250,RC,50268-411-24,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-476-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-540-11,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-563-11,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-563-11,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-686-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-686-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-687-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-709-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-709-11,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-710-11,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-710-11,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-717-11,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-717-11,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-728-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-728-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-742-11,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-742-11,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-755-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-755-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-757-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-685-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-083-01,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyvinyl Alcohol: 15 Ml In 1 Bottle (50268-678-15),250,RC,50268-678-15,NDC,,,facility,both,1,EA,,15.68,15.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-574-11,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-574-11,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-585-11,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-585-11,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-595-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-595-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-597-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-597-11,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-598-11,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-603-11,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-604-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-652-11,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-652-11,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-662-11,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-662-11,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-663-11,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-665-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-665-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyvinyl Alcohol: 15 Ml In 1 Bottle (50268-678-15),250,RC,50268-678-15,NDC,,,facility,both,1,EA,,15.65,15.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-086-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-087-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 90 Capsule In 1 Bottle (51672-4002-5),250,RC,51672-4002-5,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 90 Capsule In 1 Bottle (51672-4003-5),250,RC,51672-4003-5,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 100 Tablet In 1 Bottle (51672-4022-1),250,RC,51672-4022-1,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 100 Tablet In 1 Bottle (51672-4023-1),250,RC,51672-4023-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Warfarin Sodium: 100 Tablet In 1 Bottle (51672-4027-1),250,RC,51672-4027-1,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Warfarin Sodium: 100 Tablet In 1 Bottle (51672-4027-1),250,RC,51672-4027-1,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4037-1),250,RC,51672-4037-1,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4037-1),250,RC,51672-4037-1,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 30 Tablet In 1 Bottle (51672-4055-6),250,RC,51672-4055-6,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenytoin: 237 Ml In 1 Bottle (51672-4069-1),250,RC,51672-4069-1,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (51672-4111-1)",250,RC,51672-4111-1,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 1 Tube In 1 Carton (51672-4116-6)  / 45 G In 1 Tube,250,RC,51672-4116-6,NDC,,,facility,both,1,EA,,72.15,72.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 1 Tube In 1 Carton (51672-4116-6)  / 45 G In 1 Tube,250,RC,51672-4116-6,NDC,,,facility,both,1,EA,,72.15,72.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Tablet, Extended Release In 1 Bottle (51672-4123-1)",250,RC,51672-4123-1,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Tablet, Extended Release In 1 Bottle (51672-4123-1)",250,RC,51672-4123-1,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Tablet, Extended Release In 1 Bottle (51672-4124-1)",250,RC,51672-4124-1,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Tablet, Extended Release In 1 Bottle (51672-4124-1)",250,RC,51672-4124-1,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbamazepine: 450 Ml In 1 Bottle (51672-4047-9),250,RC,51672-4047-9,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (51672-3020-2)  / 30 G In 1 Tube,250,RC,51672-3020-2,NDC,,,facility,both,1,EA,,43.22,43.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (51672-3020-2)  / 30 G In 1 Tube,250,RC,51672-3020-2,NDC,,,facility,both,1,EA,,43.4,43.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ",250,RC,51079-991-20,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ",250,RC,51079-991-20,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (51293-628-01)",250,RC,51293-628-01,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (51407-449-01)",250,RC,51407-449-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51552-0118-3,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (51672-1258-1)  / 15 G In 1 Tube,250,RC,51672-1258-1,NDC,,,facility,both,1,EA,,14.47,14.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (51672-1259-1)  / 15 G In 1 Tube,250,RC,51672-1259-1,NDC,,,facility,both,1,EA,,9.03,9.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (51672-1267-5)  / 5 G In 1 Tube,250,RC,51672-1267-5,NDC,,,facility,both,1,EA,,116.53,116.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (51672-1267-5)  / 5 G In 1 Tube,250,RC,51672-1267-5,NDC,,,facility,both,1,EA,,116.53,116.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (51672-1312-0)  / 22 G In 1 Tube,250,RC,51672-1312-0,NDC,,,facility,both,1,EA,,11.35,11.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6)  / 45 G In 1 Tube, With Applicator",250,RC,51672-2035-6,NDC,,,facility,both,1,EA,,5.73,5.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6)  / 45 G In 1 Tube, With Applicator",250,RC,51672-2035-6,NDC,,,facility,both,1,EA,,5.9,5.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-2)  / 30 G In 1 Tube,250,RC,51672-2080-2,NDC,,,facility,both,1,EA,,13.74,13.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51672-2114-0,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51672-2115-0,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51672-2116-0,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 60 Tablet In 1 Bottle (51672-4132-4),250,RC,51672-4132-4,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenytoin: 100 Tablet, Chewable In 1 Bottle (51672-4146-1)",250,RC,51672-4146-1,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
240 mL in 1 BOTTLE (52380-1905-8) ,250,RC,52380-1905-8,NDC,,,facility,both,1,EA,,2.32,2.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zonisade: 1 Bottle In 1 Carton (52652-8001-1)  / 150 Ml In 1 Bottle,250,RC,52652-8001-1,NDC,,,facility,both,1,EA,,46.61,46.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Eprontia: 473 Ml In 1 Bottle (52652-9001-1),250,RC,52652-9001-1,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Tablet In 1 Bottle (52817-319-10),250,RC,52817-319-10,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Tablet In 1 Bottle (52817-319-10),250,RC,52817-319-10,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aplicare Povidone-Iodine: 1 G In 1 Packet (52380-0126-2),250,RC,52380-0126-2,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (52817-330-50)",250,RC,52817-330-50,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (52817-332-10)",250,RC,52817-332-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonidine Transdermal System Usp, 0.2 Mg/Day: 4 Pouch In 1 Carton (52817-611-04)  / 1 Patch In 1 Pouch / 1 D In 1 Patch",250,RC,52817-611-04,NDC,,,facility,both,1,EA,,24.25,24.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,53276-1010-02,NDC,,,facility,both,1,EA,,496.93,496.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Petroleum: 1 Tube In 1 Box (53329-068-01)  / 28.4 G In 1 Tube,250,RC,53329-068-01,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (53489-118-02)",250,RC,53489-118-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (53746-271-01),250,RC,53746-271-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (52817-330-50)",250,RC,52817-330-50,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Suprep Bowel Prep: 2 Bottle, Plastic In 1 Carton (52268-012-01)  / 177.4 Ml In 1 Bottle, Plastic",250,RC,52268-012-01,NDC,,,facility,both,1,EA,,213.02,213.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,52268-011-01,NDC,,,facility,both,1,EA,,104.43,104.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4245-1),250,RC,51672-4245-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4245-1),250,RC,51672-4245-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid In Sodium Chloride: 100 Ml In 1 Bag (51754-0108-1),250,RC,51754-0108-1,NDC,,,facility,both,1,EA,,12.62,12.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Caffeine Citrate: 1 Vial In 1 Carton (51754-0500-1)  / 3 Ml In 1 Vial,250,RC,51754-0500-1,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Acetate: 25 Vial, Single-Dose In 1 Carton (51754-2001-4)  / 20 Ml In 1 Vial, Single-Dose",250,RC,51754-2001-4,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51754-5001-1,NDC,,,facility,both,1,EA,,1.98,1.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51754-5001-1,NDC,,,facility,both,1,EA,,9.42,9.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51754-5012-1,NDC,,,facility,both,1,EA,,10.49,10.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51991-144-99,NDC,,,facility,both,1,EA,,29.03,29.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (51991-349-06)",250,RC,51991-349-06,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine Hydrochloride: 100 Tablet In 1 Bottle (51991-526-01),250,RC,51991-526-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)",250,RC,51991-877-33,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)",250,RC,51991-877-33,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-878-33)",250,RC,51991-878-33,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dificid: 1 Bottle In 1 Carton (52015-080-01)  / 20 Tablet, Film Coated In 1 Bottle",250,RC,52015-080-01,NDC,,,facility,both,1,EA,,230.48,230.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dificid: 1 Bottle In 1 Carton (52015-080-01)  / 20 Tablet, Film Coated In 1 Bottle",250,RC,52015-080-01,NDC,,,facility,both,1,EA,,228.26,228.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Theo-24: 100 Capsule, Extended Release In 1 Bottle (52244-100-10)",250,RC,52244-100-10,NDC,,,facility,both,1,EA,,6.36,6.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-986-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-986-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-286-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-286-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-375-01,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-418-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-436-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-436-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-437-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-285-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-444-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-453-01,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-453-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-458-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-458-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-527-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-565-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-444-01,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-285-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-284-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-103-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-103-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-118-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-119-01,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-141-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-164-01,NDC,,,facility,both,1,EA,,9.49,9.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-169-01,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-169-01,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-205-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-205-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-246-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-246-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-255-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-255-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-284-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-599-01,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-771-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-801-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-801-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-821-01,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-821-01,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-902-01,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-921-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-922-01,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-923-01,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-923-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-944-01,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-978-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-978-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-985-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-985-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-086-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-766-01,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-599-01,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-632-01,NDC,,,facility,both,1,EA,,5.2,5.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-632-01,NDC,,,facility,both,1,EA,,5.2,5.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-670-01,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-684-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-684-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-685-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-685-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-690-01,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-733-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-734-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-734-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-735-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-753-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-753-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,51079-759-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60)  / 60 G In 1 Tube,250,RC,50268-195-60,NDC,,,facility,both,1,EA,,6.21,6.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen Pain Reliever Fever Reducer: 100 Blister Pack In 1 Carton (45802-730-33)  / 1 Suppository In 1 Blister Pack,250,RC,45802-730-33,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen Pain Reliever Fever Reducer: 100 Blister Pack In 1 Carton (45802-730-33)  / 1 Suppository In 1 Blister Pack,250,RC,45802-730-33,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,45802-732-00,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,45802-873-03,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Polystyrene Sulfonate: 10 Bottle, Unit-Dose In 1 Carton (46287-006-60)  / 60 Ml In 1 Bottle, Unit-Dose",250,RC,46287-006-60,NDC,,,facility,both,1,EA,,43.48,43.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carospir: 118 Ml In 1 Bottle (46287-020-04),250,RC,46287-020-04,NDC,,,facility,both,1,EA,,18.91,18.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (47335-237-83)",250,RC,47335-237-83,NDC,,,facility,both,1,EA,,60.08,60.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47335-931-40,NDC,,,facility,both,1,EA,,13.45,13.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47335-932-40,NDC,,,facility,both,1,EA,,153.63,153.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 1 Bag In 1 Pouch (47335-993-01)  / 100 Ml In 1 Bag,250,RC,47335-993-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00),250,RC,45802-730-00,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00),250,RC,45802-730-00,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole Vaginal: 1 Tube In 1 Carton (45802-139-70)  / 70 G In 1 Tube,250,RC,45802-139-70,NDC,,,facility,both,1,EA,,13.11,13.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triple Antibiotic: 1 Tube In 1 Carton (45802-143-03)  / 28 G In 1 Tube,250,RC,45802-143-03,NDC,,,facility,both,1,EA,,5.18,5.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triple Antibiotic: 1 Tube In 1 Carton (45802-143-03)  / 28 G In 1 Tube,250,RC,45802-143-03,NDC,,,facility,both,1,EA,,5.15,5.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Acetaminophen: 1 Bottle In 1 Carton (45802-201-26)  / 118 Ml In 1 Bottle,250,RC,45802-201-26,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 1 Tube In 1 Carton (45802-276-03)  / 28 G In 1 Tube,250,RC,45802-276-03,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 1 Tube In 1 Carton (45802-276-03)  / 28 G In 1 Tube,250,RC,45802-276-03,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,45802-344-03,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Betamethasone Dipropionate: 1 Tube In 1 Carton (45802-376-35)  / 15 G In 1 Tube,250,RC,45802-376-35,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Betamethasone Dipropionate: 1 Tube In 1 Carton (45802-376-35)  / 15 G In 1 Tube,250,RC,45802-376-35,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 1 Tube In 1 Carton (45802-390-01)  / 60 G In 1 Tube,250,RC,45802-390-01,NDC,,,facility,both,1,EA,,252.96,252.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ammonium Lactate: 400 G In 1 Bottle, Plastic (45802-419-26)",250,RC,45802-419-26,NDC,,,facility,both,1,EA,,42.34,42.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ammonium Lactate: 400 G In 1 Bottle, Plastic (45802-419-26)",250,RC,45802-419-26,NDC,,,facility,both,1,EA,,42.34,42.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21)  / 89 Ml In 1 Bottle,250,RC,45802-433-21,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21)  / 89 Ml In 1 Bottle,250,RC,45802-433-21,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 1 Tube In 1 Carton (45802-438-03)  / 28 G In 1 Tube,250,RC,45802-438-03,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 1 Tube In 1 Carton (45802-438-03)  / 28 G In 1 Tube,250,RC,45802-438-03,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketoconazole: 120 Ml In 1 Bottle (45802-465-64),250,RC,45802-465-64,NDC,,,facility,both,1,EA,,32.38,32.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clindamycin Phosphate: 1 Bottle, With Applicator In 1 Carton (45802-562-02)  / 60 Ml In 1 Bottle, With Applicator",250,RC,45802-562-02,NDC,,,facility,both,1,EA,,43.4,43.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (45802-112-22)  / 22 G In 1 Tube,250,RC,45802-112-22,NDC,,,facility,both,1,EA,,11.56,11.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,48433-219-05,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Strong Iodine Solution: 14 Ml In 1 Bottle (48433-230-15),250,RC,48433-230-15,NDC,,,facility,both,1,EA,,47.57,47.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-124-88,NDC,,,facility,both,1,EA,,129.62,129.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-125-88,NDC,,,facility,both,1,EA,,98.37,98.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,48433-219-05,NDC,,,facility,both,1,EA,,4.14,4.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-419-88,NDC,,,facility,both,1,EA,,21.58,21.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-423-88,NDC,,,facility,both,1,EA,,33.78,33.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Beyfortus: 1 Syringe In 1 Carton (49281-575-00)  / .5 Ml In 1 Syringe,250,RC,49281-575-00,NDC,,,facility,both,1,EA,,1031.82,1031.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-590-58,NDC,,,facility,both,1,EA,,257.76,257.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-215-88,NDC,,,facility,both,1,EA,,66.11,66.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mineral Oil: 30 Ml In 1 Cup, Unit-Dose (48433-202-30)",250,RC,48433-202-30,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mineral Oil: 30 Ml In 1 Cup, Unit-Dose (48433-202-30)",250,RC,48433-202-30,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-356-11,NDC,,,facility,both,1,EA,,5.77,5.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-356-11,NDC,,,facility,both,1,EA,,5.77,5.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-357-11,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-357-11,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-358-11,NDC,,,facility,both,1,EA,,8.82,8.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-423-11,NDC,,,facility,both,1,EA,,10.29,10.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-423-11,NDC,,,facility,both,1,EA,,10.28,10.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-424-11,NDC,,,facility,both,1,EA,,9.12,9.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-426-11,NDC,,,facility,both,1,EA,,12.75,12.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-426-11,NDC,,,facility,both,1,EA,,12.75,12.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-427-11,NDC,,,facility,both,1,EA,,28.37,28.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-428-11,NDC,,,facility,both,1,EA,,30.23,30.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (47781-468-13)  / 10 Capsule In 1 Blister Pack,250,RC,47781-468-13,NDC,,,facility,both,1,EA,,16.91,16.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Disulfiram: 30 Tablet In 1 Bottle, Plastic (47781-607-30)",250,RC,47781-607-30,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-643-90),250,RC,47781-643-90,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-643-90),250,RC,47781-643-90,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-668-90),250,RC,47781-668-90,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,47781-355-11,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (45802-112-22)  / 22 G In 1 Tube,250,RC,45802-112-22,NDC,,,facility,both,1,EA,,11.39,11.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mesalamine: 60 Ml In 1 Bottle (45802-098-46),250,RC,45802-098-46,NDC,,,facility,both,1,EA,,23.64,23.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftazidime: 10 Vial In 1 Carton (44567-236-10)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,44567-236-10,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefepime: 10 Vial In 1 Carton (44567-240-10)  / 20 Ml In 1 Vial,250,RC,44567-240-10,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefepime: 10 Vial In 1 Carton (44567-241-10)  / 20 Ml In 1 Vial,250,RC,44567-241-10,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-401-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (44567-401-10)  / 1 Injection, Powder, For Solution In 1 Vial (44567-401-01)",250,RC,44567-401-10,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Bag In 1 Carton (44567-410-24)  / 100 Ml In 1 Bag,250,RC,44567-410-24,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-312-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Tray (44567-101-10)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,44567-101-10,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Urea: 85 G In 1 Bottle, Plastic (44523-617-03)",250,RC,44523-617-03,NDC,,,facility,both,1,EA,,98.58,98.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-581-01,NDC,,,facility,both,1,EA,,18.32,18.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Nitroprusside: 1 Vial, Single-Dose In 1 Carton (43598-587-23)  / 2 Ml In 1 Vial, Single-Dose",250,RC,43598-587-23,NDC,,,facility,both,1,EA,,17.71,17.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-636-52,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pyrimethamine: 30 Tablet In 1 Bottle, Plastic (43598-672-30)",250,RC,43598-672-30,NDC,,,facility,both,1,EA,,409.29,409.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carboprost Tromethamine: 1 Vial, Single-Dose In 1 Carton (43598-698-11)  / 1 Ml In 1 Vial, Single-Dose",250,RC,43598-698-11,NDC,,,facility,both,1,EA,,70.36,70.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ephedrine Sulfate: 25 Vial, Single-Dose In 1 Carton (43598-725-25)  / 1 Ml In 1 Vial, Single-Dose (43598-725-11)",250,RC,43598-725-25,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-901-11,NDC,,,facility,both,1,EA,,14.46,14.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,43598-975-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (43598-977-10)  / 100 G In 1 Tube,250,RC,43598-977-10,NDC,,,facility,both,1,EA,,18.23,18.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (43598-977-10)  / 100 G In 1 Tube,250,RC,43598-977-10,NDC,,,facility,both,1,EA,,18.09,18.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (43975-322-03)",250,RC,43975-322-03,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (43975-322-03)",250,RC,43975-322-03,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (43975-349-03)",250,RC,43975-349-03,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rhophylac: 1 Syringe, Glass In 1 Carton (44206-300-01)  / 2 Ml In 1 Syringe, Glass (44206-300-90)",250,RC,44206-300-01,NDC,,,facility,both,1,EA,,140.82,140.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44206-300-90,NDC,,,facility,both,1,EA,,142.2,142.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Bag In 1 Carton (44567-410-24)  / 100 Ml In 1 Bag,250,RC,44567-410-24,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-420-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag,250,RC,44567-420-24,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythromycin: 1 Bottle In 1 Carton (45802-038-46)  / 60 Ml In 1 Bottle,250,RC,45802-038-46,NDC,,,facility,both,1,EA,,72.33,72.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (45802-048-35)  / 15 G In 1 Tube,250,RC,45802-048-35,NDC,,,facility,both,1,EA,,13.38,13.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (45802-048-35)  / 15 G In 1 Tube,250,RC,45802-048-35,NDC,,,facility,both,1,EA,,13.35,13.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-35)  / 15 G In 1 Tube,250,RC,45802-054-35,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-35)  / 15 G In 1 Tube,250,RC,45802-054-35,NDC,,,facility,both,1,EA,,6.71,6.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 454 G In 1 Jar (45802-055-05),250,RC,45802-055-05,NDC,,,facility,both,1,EA,,38.48,38.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 454 G In 1 Jar (45802-055-05),250,RC,45802-055-05,NDC,,,facility,both,1,EA,,37.25,37.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gentamicin Sulfate: 1 Tube In 1 Carton (45802-056-35)  / 15 G In 1 Tube,250,RC,45802-056-35,NDC,,,facility,both,1,EA,,56.83,56.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (45802-059-35)  / 15 G In 1 Tube,250,RC,45802-059-35,NDC,,,facility,both,1,EA,,14,14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,45802-060-00,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-063-35)  / 15 G In 1 Tube,250,RC,45802-063-35,NDC,,,facility,both,1,EA,,6.5,6.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-065-35)  / 15 G In 1 Tube,250,RC,45802-065-35,NDC,,,facility,both,1,EA,,10.56,10.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-065-35)  / 15 G In 1 Tube,250,RC,45802-065-35,NDC,,,facility,both,1,EA,,10.55,10.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-421-24)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,44567-421-24,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-450-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-611-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-620-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-641-01,NDC,,,facility,both,1,EA,,49.52,49.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Norepinephrine Bitartrate In Sodium Chloride: 10 Bag In 1 Carton (44567-641-10)  / 250 Ml In 1 Bag (44567-641-01),250,RC,44567-641-10,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 25 Vial In 1 Carton (44567-701-25)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,44567-701-25,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 Vial In 1 Carton (44567-707-25)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,44567-707-25,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-801-10)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,44567-801-10,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,44567-820-01,NDC,,,facility,both,1,EA,,21.31,21.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60)  / 60 G In 1 Tube,250,RC,50268-195-60,NDC,,,facility,both,1,EA,,6.23,6.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tubersol: 1 Vial, Multi-Dose In 1 Carton (49281-752-21)  / 1 Ml In 1 Vial, Multi-Dose (49281-752-78)",250,RC,49281-752-21,NDC,,,facility,both,1,EA,,20.94,20.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sunmark Nasal Original: 1 Bottle, Spray In 1 Carton (49348-028-27)  / 30 Ml In 1 Bottle, Spray",250,RC,49348-028-27,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50242-100-39,NDC,,,facility,both,1,EA,,101.73,101.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-143-11,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-143-11,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-151-11,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-152-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-152-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-163-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-168-11,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-169-11,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-174-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-174-11,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-178-11,NDC,,,facility,both,1,EA,,4.13,4.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel: 20 Blister Pack In 1 Box (50268-184-12)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-184-11)",250,RC,50268-184-12,NDC,,,facility,both,1,EA,,10.38,10.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-189-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-190-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-190-11,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-169-11,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-131-11,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-131-11,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-037-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-037-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-074-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-074-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-075-11,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-087-11,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-087-11,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-088-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-088-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-089-11,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-089-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50268-098-11,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-155-76)",250,RC,49884-155-76,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-156-76)",250,RC,49884-156-76,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Megestrol Acetate: 100 Tablet In 1 Bottle (49884-289-01),250,RC,49884-289-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49884-311-52,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)",250,RC,49702-231-13,NDC,,,facility,both,1,EA,,230.93,230.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49884-315-52,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49884-315-52,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49884-321-52,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pimozide: 100 Tablet In 1 Bottle (49884-347-01),250,RC,49884-347-01,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49884-465-64,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methimazole: 100 TABLET in 1 BOTTLE (49884-640-01) ,250,RC,49884-640-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dapsone: 2 Blister Pack In 1 Carton (49938-101-30)  / 15 Tablet In 1 Blister Pack,250,RC,49938-101-30,NDC,,,facility,both,1,EA,,5.08,5.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 7 Blister Pack In 1 Carton (49884-311-91)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack (49884-311-52)",250,RC,49884-311-91,NDC,,,facility,both,1,EA,,6.32,6.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)",250,RC,49702-231-13,NDC,,,facility,both,1,EA,,234.8,234.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)",250,RC,49702-228-13,NDC,,,facility,both,1,EA,,139.21,139.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sunmark Childrens Pain And Fever: 1 Bottle In 1 Carton (49348-119-34)  / 118 Ml In 1 Bottle,250,RC,49348-119-34,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Antibiotic Bacitracin Zinc: 1 Tube In 1 Carton (49348-154-72)  / 28.4 G In 1 Tube,250,RC,49348-154-72,NDC,,,facility,both,1,EA,,4.45,4.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sunmark Miconazole 7: 1 Tube, With Applicator In 1 Carton (49348-530-77)  / 45 G In 1 Tube, With Applicator",250,RC,49348-530-77,NDC,,,facility,both,1,EA,,13.5,13.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sunmark Nicotine: 110 Blister Pack In 1 Carton (49348-573-36)  / 1 Gum, Chewing In 1 Blister Pack",250,RC,49348-573-36,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gas Relief Drops Infants: 1 Bottle, Dropper In 1 Carton (49348-740-27)  / 30 Ml In 1 Bottle, Dropper",250,RC,49348-740-27,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49348-740-53,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sunmark stay awake: 16 BLISTER PACK in 1 CARTON (49348-771-03)  / 1 TABLET in 1 BLISTER PACK,250,RC,49348-771-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sunmark stay awake: 16 BLISTER PACK in 1 CARTON (49348-771-03)  / 1 TABLET in 1 BLISTER PACK,250,RC,49348-771-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Athletes Foot: 1 Tube In 1 Carton (49348-790-72)  / 30 G In 1 Tube,250,RC,49348-790-72,NDC,,,facility,both,1,EA,,12.76,12.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Senna Time: 1000 Tablet, Coated In 1 Bottle, Plastic (49483-080-10)",250,RC,49483-080-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Senna Time: 1000 Tablet, Coated In 1 Bottle, Plastic (49483-080-10)",250,RC,49483-080-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49502-102-01,NDC,,,facility,both,1,EA,,249.61,249.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epivir: 240 Ml In 1 Bottle (49702-205-48),250,RC,49702-205-48,NDC,,,facility,both,1,EA,,9.98,9.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)",250,RC,49702-228-13,NDC,,,facility,both,1,EA,,140.08,140.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)",250,RC,49702-228-13,NDC,,,facility,both,1,EA,,139.26,139.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-327-01),250,RC,50111-327-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-327-01),250,RC,50111-327-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-328-01),250,RC,50111-328-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-194-60)",250,RC,50228-194-60,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (50228-232-01),250,RC,50228-232-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (50228-459-01),250,RC,50228-459-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50242-037-06,NDC,,,facility,both,1,EA,,298.5,298.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50242-037-06,NDC,,,facility,both,1,EA,,295.14,295.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 10 Vial In 1 Carton (50242-041-10)  / 2 Ml In 1 Vial,250,RC,50242-041-10,NDC,,,facility,both,1,EA,,176.01,176.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,250,RC,50242-041-64,NDC,,,facility,both,1,EA,,161.14,161.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,250,RC,50242-041-64,NDC,,,facility,both,1,EA,,174.22,174.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,50242-044-06,NDC,,,facility,both,1,EA,,167.31,167.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-194-60)",250,RC,50228-194-60,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,49281-752-78,NDC,,,facility,both,1,EA,,18.79,18.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-193-60)",250,RC,50228-193-60,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-328-01),250,RC,50111-328-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Tablet In 1 Bottle (50111-334-01),250,RC,50111-334-01,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-398-01),250,RC,50111-398-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-398-01),250,RC,50111-398-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 500 Tablet In 1 Bottle (50111-560-02),250,RC,50111-560-02,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 500 Tablet In 1 Bottle (50111-560-02),250,RC,50111-560-02,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-787-10)",250,RC,50111-787-10,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (50111-915-01),250,RC,50111-915-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (50111-915-01),250,RC,50111-915-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (50111-918-01),250,RC,50111-918-01,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (50111-918-01),250,RC,50111-918-01,NDC,,,facility,both,1,EA,,3.24,3.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (50228-158-01),250,RC,50228-158-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-192-60)",250,RC,50228-192-60,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-192-60)",250,RC,50228-192-60,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-193-60)",250,RC,50228-193-60,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (16714-137-01)  / 50 Ml In 1 Vial, Multi-Dose",250,RC,16714-137-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-0477-21,NDC,,,facility,both,1,EA,,51.24,51.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-1410-31,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-1410-31,NDC,,,facility,both,1,EA,,2.65,2.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6001-01,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6007-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6007-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6008-01,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21),250,RC,0641-0376-25,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82)  / 1 Capsule In 1 Blister Pack,250,RC,0597-0360-82,NDC,,,facility,both,1,EA,,5.66,5.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 473 Ml In 1 Bottle, Plastic (0603-1542-58)",250,RC,0603-1542-58,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0603-1880-10,NDC,,,facility,both,1,EA,,4.13,4.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0603-1880-10,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Baclofen: 100 Tablet In 1 Bottle, Plastic (0603-2406-21)",250,RC,0603-2406-21,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Baclofen: 100 Tablet In 1 Bottle, Plastic (0603-2406-21)",250,RC,0603-2406-21,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Benztropine Mesylate: 100 Tablet In 1 Bottle, Plastic (0603-2434-21)",250,RC,0603-2434-21,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Benztropine Mesylate: 100 Tablet In 1 Bottle, Plastic (0603-2434-21)",250,RC,0603-2434-21,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0603-3078-21) ",250,RC,0603-3078-21,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0603-3078-21) ",250,RC,0603-3078-21,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-0367-21,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-0376-21,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-0376-21,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21),250,RC,0641-0376-25,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6013-01,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82)  / 1 Capsule In 1 Blister Pack,250,RC,0597-0360-82,NDC,,,facility,both,1,EA,,5.67,5.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6014-01,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6015-01,NDC,,,facility,both,1,EA,,9.36,9.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6061-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6061-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6084-01,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6103-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6116-01,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6117-01,NDC,,,facility,both,1,EA,,3.72,3.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6125-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6060-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6059-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6027-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Citrate: 50 Ml In 1 Vial (0641-6030-01),250,RC,0641-6030-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Infumorph 200: 20 Ml In 1 Ampule (0641-6039-01),250,RC,0641-6039-01,NDC,,,facility,both,1,EA,,14.98,14.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6042-01,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6044-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6046-01,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meperidine Hydrochloride: 25 Vial In 1 Carton (0641-6053-25)  / 1 Ml In 1 Vial (0641-6053-01),250,RC,0641-6053-25,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6057-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diltiazem Hydrochloride: 10 Vial In 1 Carton (0641-6014-10)  / 10 Ml In 1 Vial (0641-6014-01),250,RC,0641-6014-10,NDC,,,facility,both,1,EA,,4.14,4.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 60 Blister Pack In 1 Carton (0597-0355-56)  / 1 Capsule In 1 Blister Pack,250,RC,0597-0355-56,NDC,,,facility,both,1,EA,,5.66,5.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bromocriptine Mesylate: 100 Tablet In 1 Bottle, Plastic (0574-0106-01)",250,RC,0574-0106-01,NDC,,,facility,both,1,EA,,3.26,3.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0574-0107-70)",250,RC,0574-0107-70,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0574-0107-70)",250,RC,0574-0107-70,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiloride Hydrochloride: 100 Tablet In 1 Bottle (0574-0292-01),250,RC,0574-0292-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Actidose Aqua: 240 Ml In 1 Tube (0574-0521-76),250,RC,0574-0521-76,NDC,,,facility,both,1,EA,,27.29,27.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclosporine: 10 AMPULE in 1 CARTON (0574-0866-10)  / 5 mL in 1 AMPULE,250,RC,0574-0866-10,NDC,,,facility,both,1,EA,,16.76,16.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystop: 15 G In 1 Bottle, Plastic (0574-2008-15)",250,RC,0574-2008-15,NDC,,,facility,both,1,EA,,9.52,9.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystop: 15 G In 1 Bottle, Plastic (0574-2008-15)",250,RC,0574-2008-15,NDC,,,facility,both,1,EA,,9.93,9.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bromocriptine Mesylate: 100 Tablet In 1 Bottle, Plastic (0574-0106-01)",250,RC,0574-0106-01,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0574-4024-11,NDC,,,facility,both,1,EA,,13.1,13.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12)  / 1 Suppository In 1 Blister Pack,250,RC,0574-7050-12,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12)  / 1 Suppository In 1 Blister Pack,250,RC,0574-7050-12,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bisacodyl: 50 Blister Pack In 1 Carton (0574-7050-50)  / 1 Suppository In 1 Blister Pack,250,RC,0574-7050-50,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bisacodyl: 50 Blister Pack In 1 Carton (0574-7050-50)  / 1 Suppository In 1 Blister Pack,250,RC,0574-7050-50,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Compro: 12 Packet In 1 Carton (0574-7226-12)  / 1 Suppository In 1 Packet,250,RC,0574-7226-12,NDC,,,facility,both,1,EA,,12.57,12.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 1 Bottle In 1 Carton (0574-9855-10)  / 100 Capsule In 1 Bottle,250,RC,0574-9855-10,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrochlorothiazide: 100 Capsule, Gelatin Coated In 1 Bottle (0591-0347-01)",250,RC,0591-0347-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aspirin: 12 Packet In 1 Carton (0574-7034-12)  / 1 Suppository In 1 Packet,250,RC,0574-7034-12,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0573-0513-15,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0573-0513-15,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Medroxyprogesterone Acetate: 1 Vial, Single-Dose In 1 Carton (0548-5400-00)  / 1 Ml In 1 Vial, Single-Dose",250,RC,0548-5400-00,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 10 Syringe In 1 Carton (0548-5601-00)  / .3 Ml In 1 Syringe,250,RC,0548-5601-00,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 1 Vial In 1 Carton (0548-5608-00)  / 3 Ml In 1 Vial,250,RC,0548-5608-00,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial,250,RC,0548-5900-00,NDC,,,facility,both,1,EA,,33.18,33.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0033-02),250,RC,0555-0033-02,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isoniazid: 30 Tablet In 1 Bottle, Unit-Dose (0555-0071-01)",250,RC,0555-0071-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0159-02),250,RC,0555-0159-02,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Megestrol Acetate: 100 Tablet In 1 Bottle (0555-0606-02),250,RC,0555-0606-02,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0779-02),250,RC,0555-0779-02,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0872-02),250,RC,0555-0872-02,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fludrocortisone Acetate: 100 Tablet In 1 Bottle (0555-0997-02),250,RC,0555-0997-02,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrochlorothiazide: 100 Capsule, Gelatin Coated In 1 Bottle (0591-0347-01)",250,RC,0591-0347-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrochlorothiazide: 500 Capsule, Gelatin Coated In 1 Bottle (0591-0347-05)",250,RC,0591-0347-05,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Perphenazine: 100 Tablet, Film Coated In 1 Bottle (0591-4103-01)",250,RC,0591-4103-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0591-5335-01)",250,RC,0591-5335-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Probenecid: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-5347-01)",250,RC,0591-5347-01,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allopurinol: 100 Tablet In 1 Bottle, Plastic (0591-5543-01)",250,RC,0591-5543-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allopurinol: 100 Tablet In 1 Bottle, Plastic (0591-5543-01)",250,RC,0591-5543-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0597-0053-01,NDC,,,facility,both,1,EA,,135.66,135.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atrovent Hfa: 1 Canister In 1 Carton (0597-0087-17)  / 200 Aerosol, Metered In 1 Canister",250,RC,0597-0087-17,NDC,,,facility,both,1,EA,,554.56,554.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atrovent Hfa: 1 Canister In 1 Carton (0597-0087-17)  / 200 Aerosol, Metered In 1 Canister",250,RC,0597-0087-17,NDC,,,facility,both,1,EA,,640.93,640.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spiriva Respimat: 1 Cartridge In 1 Carton (0597-0100-51)  / 10 Spray, Metered In 1 Cartridge",250,RC,0597-0100-51,NDC,,,facility,both,1,EA,,67.78,67.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spiriva Respimat: 1 Cartridge In 1 Carton (0597-0100-51)  / 10 Spray, Metered In 1 Cartridge",250,RC,0597-0100-51,NDC,,,facility,both,1,EA,,67.61,67.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 10 Blister Pack In 1 Carton (0597-0108-60)  / 6 Capsule In 1 Blister Pack,250,RC,0597-0108-60,NDC,,,facility,both,1,EA,,5.68,5.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0597-0152-37,NDC,,,facility,both,1,EA,,24.9,24.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0597-0152-37,NDC,,,facility,both,1,EA,,24.82,24.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0597-0153-37,NDC,,,facility,both,1,EA,,24.89,24.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0597-0153-37,NDC,,,facility,both,1,EA,,24.41,24.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproic: 100 Capsule, Liquid Filled In 1 Bottle (0591-4012-01)",250,RC,0591-4012-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6127-01,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Loxapine: 100 Capsule In 1 Bottle, Plastic (0591-0371-01)",250,RC,0591-0371-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0404-01)",250,RC,0591-0404-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Guanfacine: 100 Tablet In 1 Bottle, Plastic (0591-0444-01)",250,RC,0591-0444-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Guanfacine: 100 Tablet In 1 Bottle, Plastic (0591-0444-01)",250,RC,0591-0444-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0605-01)",250,RC,0591-0605-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0605-01)",250,RC,0591-0605-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0606-01)",250,RC,0591-0606-01,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0607-01)",250,RC,0591-0607-01,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0607-01)",250,RC,0591-0607-01,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0591-2258-54,NDC,,,facility,both,1,EA,,17.73,17.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desmopressin Acetate: 100 TABLET in 1 BOTTLE, PLASTIC (0591-2464-01) ",250,RC,0591-2464-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Colchicine: 100 Tablet, Film Coated In 1 Bottle (0591-2562-01)",250,RC,0591-2562-01,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Colchicine: 100 Tablet, Film Coated In 1 Bottle (0591-2562-01)",250,RC,0591-2562-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0591-3525-11,NDC,,,facility,both,1,EA,,2.78,2.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0591-3525-11,NDC,,,facility,both,1,EA,,2.76,2.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)",250,RC,0591-3541-60,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)",250,RC,0591-3541-60,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Bottle (0591-3659-30)",250,RC,0591-3659-30,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ready-To-Use: 1 Bottle In 1 Carton (0536-7415-51)  / 133 Ml In 1 Bottle,250,RC,0536-7415-51,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6127-01,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Package (0641-6127-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6127-01)",250,RC,0641-6127-25,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3404-85,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3407-78,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3408-80,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3411-70,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3433-46,NDC,,,facility,both,1,EA,,3.93,3.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmedetomidine Hydrochloride In 0.9% Sodium Chloride: 10 Vial In 1 Carton (0781-3493-95)  / 20 Ml In 1 Vial,250,RC,0781-3493-95,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3545-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3290-91,NDC,,,facility,both,1,EA,,5.69,5.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3152-70,NDC,,,facility,both,1,EA,,9.16,9.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cisatracurium Besylate: 10 Vial, Multi-Dose In 1 Carton (0781-3152-95)  / 10 Ml In 1 Vial, Multi-Dose (0781-3152-70)",250,RC,0781-3152-95,NDC,,,facility,both,1,EA,,9.6,9.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Vial, Glass In 1 Carton (0781-3156-95)  / 100 Ml In 1 Vial, Glass (0781-3156-06)",250,RC,0781-3156-95,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3158-94,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial,250,RC,0781-3159-72,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial,250,RC,0781-3159-72,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3269-71,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3269-71,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ephedrine Sulfate: 10 Vial, Single-Dose In 1 Carton (0781-3269-95)  / 1 Ml In 1 Vial, Single-Dose (0781-3269-71)",250,RC,0781-3269-95,NDC,,,facility,both,1,EA,,2.75,2.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3289-91,NDC,,,facility,both,1,EA,,6.39,6.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3545-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3545-25)  / 1 Ml In 1 Vial, Multi-Dose (0781-3545-10)",250,RC,0781-3545-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-7304-58,NDC,,,facility,both,1,EA,,24.43,24.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Tablet In 1 Bottle (0781-8052-01),250,RC,0781-8052-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-9407-78,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxybutynin Chloride: 100 Tablet In 1 Bottle (0832-0038-00),250,RC,0832-0038-00,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxybutynin Chloride: 100 Tablet In 1 Bottle (0832-0038-00),250,RC,0832-0038-00,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-0038-89,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-0038-89,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nyamyc: 1 Bottle, Plastic In 1 Carton (0832-0465-60)  / 60 G In 1 Bottle, Plastic",250,RC,0832-0465-60,NDC,,,facility,both,1,EA,,68.68,68.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenoxylate hydrochloride and atropine sulfate: 100 TABLET in 1 BOTTLE (0832-0590-11) ,250,RC,0832-0590-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-1211-89,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-1211-89,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-1213-89,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-1213-89,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol: 100 Tablet In 1 Bottle (0832-1510-11),250,RC,0832-1510-11,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (0832-7122-11)",250,RC,0832-7122-11,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (0832-7122-11)",250,RC,0832-7122-11,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-0512-89,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-6153-94,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin G Potassium: 1 Vial In 1 Carton (0781-6136-94)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,0781-6136-94,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3545-25)  / 1 Ml In 1 Vial, Multi-Dose (0781-3545-10)",250,RC,0781-3545-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3755-75,NDC,,,facility,both,1,EA,,6.2,6.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (0781-3755-95)  / 4 Ml In 1 Vial, Single-Dose (0781-3755-75)",250,RC,0781-3755-95,NDC,,,facility,both,1,EA,,6.16,6.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine sodium: 90 TABLET in 1 BOTTLE (0781-5181-92) ,250,RC,0781-5181-92,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine sodium: 90 TABLET in 1 BOTTLE (0781-5186-92) ,250,RC,0781-5186-92,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5439-20)",250,RC,0781-5439-20,NDC,,,facility,both,1,EA,,9.2,9.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5439-20)",250,RC,0781-5439-20,NDC,,,facility,both,1,EA,,9.26,9.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5654-01)",250,RC,0781-5654-01,NDC,,,facility,both,1,EA,,5.43,5.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (0781-5668-31)",250,RC,0781-5668-31,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (0781-5668-31)",250,RC,0781-5668-31,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5669-01)",250,RC,0781-5669-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5669-01)",250,RC,0781-5669-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clarithromycin: 50 Ml In 1 Bottle (0781-6023-52),250,RC,0781-6023-52,NDC,,,facility,both,1,EA,,22.2,22.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin G Potassium: 10 Vial In 1 Carton (0781-6135-95)  / 1 Injection, Powder, For Solution In 1 Vial (0781-6135-94)",250,RC,0781-6135-95,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3114-91,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3113-90,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6205-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6228-01,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6231-01,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6244-01,NDC,,,facility,both,1,EA,,13.94,13.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6267-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial,250,RC,0703-0018-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),250,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),250,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),250,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),250,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6176-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6132-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6146-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6149-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0641-6174-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0113-03)  / 5 Ml In 1 Vial (0703-0113-01),250,RC,0703-0113-03,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1488-01)",250,RC,0781-1488-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1488-01)",250,RC,0781-1488-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atenolol: 100 TABLET in 1 BOTTLE (0781-1507-01) ,250,RC,0781-1507-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1556-01),250,RC,0781-1556-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1556-01),250,RC,0781-1556-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 1000 Tablet In 1 Bottle (0781-1556-10),250,RC,0781-1556-10,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1635-01),250,RC,0781-1635-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1695-01),250,RC,0781-1695-01,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1695-01),250,RC,0781-1695-01,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 1000 Tablet In 1 Bottle (0781-1695-10),250,RC,0781-1695-10,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (0781-1831-20)",250,RC,0781-1831-20,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (0781-1831-20)",250,RC,0781-1831-20,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 40 Tablet, Multilayer, Extended Release In 1 Bottle (0781-1943-39)",250,RC,0781-1943-39,NDC,,,facility,both,1,EA,,8.57,8.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 40 Tablet, Multilayer, Extended Release In 1 Bottle (0781-1943-39)",250,RC,0781-1943-39,NDC,,,facility,both,1,EA,,9.26,9.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3040-72,NDC,,,facility,both,1,EA,,21.77,21.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0781-3110-90,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1487-01)",250,RC,0781-1487-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1487-01)",250,RC,0781-1487-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0703-9514-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sulfamethoxazole And Trimethoprim: 1 Vial, Multi-Dose In 1 Carton (0703-9526-01)  / 30 Ml In 1 Vial, Multi-Dose",250,RC,0703-9526-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0713-0503-06,NDC,,,facility,both,1,EA,,18.64,18.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0713-0503-06,NDC,,,facility,both,1,EA,,20.13,20.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mometasone Furoate: 1 Tube In 1 Carton (0713-0634-15)  / 15 G In 1 Tube,250,RC,0713-0634-15,NDC,,,facility,both,1,EA,,21.14,21.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mometasone Furoate: 1 Tube In 1 Carton (0713-0635-15)  / 15 G In 1 Tube,250,RC,0713-0635-15,NDC,,,facility,both,1,EA,,8.33,8.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 1 Tube In 1 Carton (0713-0637-37)  / 45 G In 1 Tube,250,RC,0713-0637-37,NDC,,,facility,both,1,EA,,94.7,94.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (0713-0678-15)  / 15 G In 1 Tube,250,RC,0713-0678-15,NDC,,,facility,both,1,EA,,11.64,11.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (0713-0678-15)  / 15 G In 1 Tube,250,RC,0713-0678-15,NDC,,,facility,both,1,EA,,11.74,11.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gentamicin Sulfate: 1 Tube In 1 Carton (0713-0683-15)  / 15 G In 1 Tube,250,RC,0713-0683-15,NDC,,,facility,both,1,EA,,71.39,71.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01),250,RC,0781-1061-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01),250,RC,0781-1061-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1077-01),250,RC,0781-1077-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1077-01),250,RC,0781-1077-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1079-01),250,RC,0781-1079-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ready-To-Use: 1 Bottle In 1 Carton (0536-7415-51)  / 133 Ml In 1 Bottle,250,RC,0536-7415-51,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicotine: 14 Pouch In 1 Carton (0536-5896-88)  / 1 H In 1 Pouch,250,RC,0536-5896-88,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (0409-7391-72)  / 15 Ml In 1 Vial, Single-Dose (0409-7391-82)",250,RC,0409-7391-72,NDC,,,facility,both,1,EA,,23.48,23.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7391-82,NDC,,,facility,both,1,EA,,25.62,25.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7419-14,NDC,,,facility,both,1,EA,,63.7,63.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7517-66,NDC,,,facility,both,1,EA,,24.85,24.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7650-05,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 POUCH in 1 CASE (0409-7811-24)  / 1 BAG in 1 POUCH / 100 mL in 1 BAG (0409-7811-31) ,250,RC,0409-7811-24,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride in Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7902-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7902-09,NDC,,,facility,both,1,EA,,13.72,13.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 POUCH in 1 CASE (0409-7922-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG,250,RC,0409-7922-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7335-13,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amidate: 10 Vial, Single-Dose In 1 Tray (0409-6695-01)  / 10 Ml In 1 Vial, Single-Dose (0409-6695-11)",250,RC,0409-6695-01,NDC,,,facility,both,1,EA,,10.44,10.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6729-11,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag (0409-6729-41),250,RC,0409-6729-23,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC",250,RC,0409-7138-09,NDC,,,facility,both,1,EA,,9.5,9.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC",250,RC,0409-7138-09,NDC,,,facility,both,1,EA,,9.62,9.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC",250,RC,0409-7138-09,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 12 BOTTLE, PLASTIC in 1 CASE (0409-7139-09)  / 1000 mL in 1 BOTTLE, PLASTIC",250,RC,0409-7139-09,NDC,,,facility,both,1,EA,,11.57,11.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hetastarch In Sodium Chloride: 12 Container In 1 Case (0409-7248-03)  / 500 Ml In 1 Container (0409-7248-13),250,RC,0409-7248-03,NDC,,,facility,both,1,EA,,13.07,13.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7295-11,NDC,,,facility,both,1,EA,,12.98,12.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Acetate: 25 Vial, Single-Dose In 1 Tray (0409-7299-73)  / 20 Ml In 1 Vial, Single-Dose (0409-7299-83)",250,RC,0409-7299-73,NDC,,,facility,both,1,EA,,7.16,7.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7299-83,NDC,,,facility,both,1,EA,,8.21,8.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-7332-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6653-18,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG,250,RC,0409-7984-36,NDC,,,facility,both,1,EA,,4.59,4.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG,250,RC,0409-7984-37,NDC,,,facility,both,1,EA,,9.48,9.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 POUCH in 1 CASE (0409-7985-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7985-09,NDC,,,facility,both,1,EA,,9.65,9.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 12 POUCH in 1 CASE (0409-7990-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7990-09,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride And Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-9042-01)  / 10 Ml In 1 Vial, Single-Dose (0409-9042-11)",250,RC,0409-9042-01,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride And Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-9042-01)  / 10 Ml In 1 Vial, Single-Dose (0409-9042-11)",250,RC,0409-9042-01,NDC,,,facility,both,1,EA,,33.81,33.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Citrate: 10 Ampule In 1 Cello Pack (0409-9093-32)  / 2 Ml In 1 Ampule (0409-9093-37),250,RC,0409-9093-32,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",250,RC,0409-9094-22,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",250,RC,0409-9094-22,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-9094-41,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Carton In 1 Tray (0409-9094-61)  / 1 Vial, Single-Dose In 1 Carton / 50 Ml In 1 Vial, Single-Dose (0409-9094-41)",250,RC,0409-9094-61,NDC,,,facility,both,1,EA,,5.1,5.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-9094-12,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 BAG in 1 CASE (0409-7983-25)  / 250 mL in 1 BAG,250,RC,0409-7983-25,NDC,,,facility,both,1,EA,,14.38,14.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers and Dextrose: 12 POUCH in 1 CASE (0409-7929-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7929-09,NDC,,,facility,both,1,EA,,8.55,8.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7941-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7941-09,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 POUCH in 1 CASE (0409-7953-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,250,RC,0409-7953-03,NDC,,,facility,both,1,EA,,10.79,10.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 POUCH in 1 CASE (0409-7953-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7953-09,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 POUCH in 1 CASE (0409-7953-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7953-09,NDC,,,facility,both,1,EA,,8.03,8.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG,250,RC,0409-7983-02,NDC,,,facility,both,1,EA,,12.61,12.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,250,RC,0409-7983-03,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,250,RC,0409-7983-03,NDC,,,facility,both,1,EA,,10.93,10.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 POUCH in 1 CASE (0409-7983-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7983-09,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 POUCH in 1 CASE (0409-7983-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,250,RC,0409-7983-09,NDC,,,facility,both,1,EA,,6.54,6.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6648-16,NDC,,,facility,both,1,EA,,5.71,5.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 25 Vial, Plastic In 1 Tray (0409-4887-10)  / 10 Ml In 1 Vial, Plastic (0409-4887-17)",250,RC,0409-4887-10,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4887-23,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4887-24,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4887-25,NDC,,,facility,both,1,EA,,7.36,7.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4888-02,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4888-03,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4888-06,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4888-06,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-4888-10)  / 10 Ml In 1 Vial, Single-Dose (0409-4888-02)",250,RC,0409-4888-10,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4902-64,NDC,,,facility,both,1,EA,,14.12,14.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",250,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4928-11,NDC,,,facility,both,1,EA,,20.88,20.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Chloride: 10 Carton In 1 Container (0409-4928-34)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,250,RC,0409-4928-34,NDC,,,facility,both,1,EA,,30.8,30.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-4888-10)  / 10 Ml In 1 Vial, Single-Dose (0409-4888-02)",250,RC,0409-4888-10,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4699-54,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4279-16,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 25 Ampule In 1 Carton (0409-4282-02)  / 10 Ml In 1 Ampule (0409-4282-12),250,RC,0409-4282-02,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4282-12,NDC,,,facility,both,1,EA,,3.2,3.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)",250,RC,0409-4332-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)",250,RC,0409-4332-01,NDC,,,facility,both,1,EA,,4.25,4.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4332-11,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4520-02,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4520-02,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 10 Vial In 1 Tray (0409-4699-24)  / 100 Ml In 1 Vial (0409-4699-54),250,RC,0409-4699-24,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Tray (0409-4699-33)  / 50 Ml In 1 Vial (0409-4699-53),250,RC,0409-4699-33,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Tray (0409-4699-33)  / 50 Ml In 1 Vial (0409-4699-53),250,RC,0409-4699-33,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-5084-13,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 24 BOTTLE, PLASTIC in 1 CASE (0409-6138-03)  / 500 mL in 1 BOTTLE, PLASTIC",250,RC,0409-6138-03,NDC,,,facility,both,1,EA,,10.48,10.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 24 BOTTLE, PLASTIC in 1 CASE (0409-6138-03)  / 500 mL in 1 BOTTLE, PLASTIC",250,RC,0409-6138-03,NDC,,,facility,both,1,EA,,9.86,9.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 24 BOTTLE, PLASTIC in 1 CASE (0409-6139-03)  / 500 mL in 1 BOTTLE, PLASTIC",250,RC,0409-6139-03,NDC,,,facility,both,1,EA,,8.97,8.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6482-11,NDC,,,facility,both,1,EA,,46.58,46.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6531-12,NDC,,,facility,both,1,EA,,8.1,8.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6533-11,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate: 25 VIAL in 1 TRAY (0409-6625-02)  / 50 mL in 1 VIAL,250,RC,0409-6625-02,NDC,,,facility,both,1,EA,,15.59,15.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6625-22,NDC,,,facility,both,1,EA,,14.08,14.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-6635-01)  / 5 Ml In 1 Vial, Single-Dose (0409-6635-18)",250,RC,0409-6635-01,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6637-24,NDC,,,facility,both,1,EA,,31.56,31.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6637-24,NDC,,,facility,both,1,EA,,31.26,31.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextrose: 25 Vial, Single-Dose In 1 Tray (0409-6648-02)  / 50 Ml In 1 Vial, Single-Dose (0409-6648-16)",250,RC,0409-6648-02,NDC,,,facility,both,1,EA,,7.45,7.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Carton In 1 Tray (0409-9094-61)  / 1 Vial, Single-Dose In 1 Carton / 50 Ml In 1 Vial, Single-Dose (0409-9094-41)",250,RC,0409-9094-61,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-5921-16,NDC,,,facility,both,1,EA,,4.43,4.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)",250,RC,0409-6102-04,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)",250,RC,0409-6102-04,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6102-18,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Primidone: 100 Tablet In 1 Bottle (0527-1231-01),250,RC,0527-1231-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Primidone: 100 Tablet In 1 Bottle (0527-1301-01),250,RC,0527-1301-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pilocarpine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0527-1313-01)",250,RC,0527-1313-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pilocarpine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0527-1313-01)",250,RC,0527-1313-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Loxapine: 100 Capsule In 1 Bottle, Plastic (0527-1395-01)",250,RC,0527-1395-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1790-01)",250,RC,0527-1790-01,NDC,,,facility,both,1,EA,,5.67,5.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 1 Bottle, Plastic In 1 Carton (0527-1948-66)  / 100 Ml In 1 Bottle, Plastic",250,RC,0527-1948-66,NDC,,,facility,both,1,EA,,139.24,139.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (0527-2133-35)",250,RC,0527-2133-35,NDC,,,facility,both,1,EA,,15.61,15.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (0527-3281-46),250,RC,0527-3281-46,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (0527-3281-46),250,RC,0527-3281-46,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (0527-4591-13)  / 10 Capsule In 1 Blister Pack,250,RC,0527-4591-13,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oseltamivir Phosphate: 1 Bottle, Plastic In 1 Carton (0527-5137-62)  / 60 Ml In 1 Bottle, Plastic",250,RC,0527-5137-62,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 1 Bottle In 1 Carton (0527-6004-80)  / 50 Ml In 1 Bottle,250,RC,0527-6004-80,NDC,,,facility,both,1,EA,,45.28,45.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexmethylphenidate Hydrochloride Extended-Release: 100 Capsule, Extended Release In 1 Bottle (0527-8106-37)",250,RC,0527-8106-37,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate Antacid: 1000 Tablet In 1 Bottle (0536-1046-10),250,RC,0536-1046-10,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate Antacid: 1000 Tablet In 1 Bottle (0536-1047-10),250,RC,0536-1047-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate Antacid: 1000 Tablet In 1 Bottle (0536-1047-10),250,RC,0536-1047-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0521-2345-00,NDC,,,facility,both,1,EA,,8.66,8.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0521-2311-00,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose",250,RC,0517-4602-25,NDC,,,facility,both,1,EA,,9.41,9.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose",250,RC,0517-4602-25,NDC,,,facility,both,1,EA,,9.41,9.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitroglycerin: 25 Vial, Single-Dose In 1 Tray (0517-4810-25)  / 10 Ml In 1 Vial, Single-Dose (0517-4810-01)",250,RC,0517-4810-25,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-5601-01,NDC,,,facility,both,1,EA,,19.35,19.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxyzine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0517-5601-25)  / 1 Ml In 1 Vial, Single-Dose (0517-5601-01)",250,RC,0517-5601-25,NDC,,,facility,both,1,EA,,18.05,18.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-7604-01,NDC,,,facility,both,1,EA,,7.46,7.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7604-25)  / 4 Ml In 1 Vial, Glass",250,RC,0517-7604-25,NDC,,,facility,both,1,EA,,7.46,7.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-9702-01,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0521-2311-00,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Benzoyl Peroxide Acne Medication: 1 Tube In 1 Carton (0536-1055-56)  / 42.5 Ml In 1 Tube,250,RC,0536-1055-56,NDC,,,facility,both,1,EA,,7.09,7.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Hemorrhoidal: 12 Blister Pack In 1 Carton (0536-1186-12)  / 1 Suppository In 1 Blister Pack,250,RC,0536-1186-12,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Carbonate 10 Gr (648 Mg) (Antacid): 1000 Tablet In 1 Bottle, Plastic (0536-1206-10)",250,RC,0536-1206-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Maxi Nicotine: 3 Bottle, Plastic In 1 Box (0536-1338-09)  / 24 Lozenge In 1 Bottle, Plastic",250,RC,0536-1338-09,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Muscle Rub Cream: 1 Tube In 1 Carton (0536-1349-57)  / 85 G In 1 Tube,250,RC,0536-1349-57,NDC,,,facility,both,1,EA,,4.5,4.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Muscle Rub Cream: 1 Tube In 1 Carton (0536-1349-57)  / 85 G In 1 Tube,250,RC,0536-1349-57,NDC,,,facility,both,1,EA,,4.44,4.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Nicotine Polacrilex Gum, Mint Flavor: 11 Blister Pack In 1 Carton (0536-1362-23)  / 10 Gum, Chewing In 1 Blister Pack",250,RC,0536-1362-23,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0536-1362-25,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate 2% Cream Antifungal: 1 Tube In 1 Box (0536-1375-75)  / 28.3 G In 1 Tube,250,RC,0536-1375-75,NDC,,,facility,both,1,EA,,4.59,4.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate 2% Cream Antifungal: 1 Tube In 1 Box (0536-1375-75)  / 28.3 G In 1 Tube,250,RC,0536-1375-75,NDC,,,facility,both,1,EA,,4.94,4.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94)  / 15 Ml In 1 Bottle, Dropper",250,RC,0536-1408-94,NDC,,,facility,both,1,EA,,9.67,9.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Capsaicin: 1 Tube In 1 Carton (0536-2525-25)  / 60 G In 1 Tube,250,RC,0536-2525-25,NDC,,,facility,both,1,EA,,10.12,10.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0536-3029-25,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicotine: 14 Pouch In 1 Carton (0536-5895-88)  / 1 H In 1 Pouch,250,RC,0536-5895-88,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicotine: 14 Pouch In 1 Carton (0536-5895-88)  / 1 H In 1 Pouch,250,RC,0536-5895-88,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicotine: 14 Pouch In 1 Carton (0536-5896-88)  / 1 H In 1 Pouch,250,RC,0536-5896-88,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94)  / 15 Ml In 1 Bottle, Dropper",250,RC,0536-1408-94,NDC,,,facility,both,1,EA,,9.68,9.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Regular Strength Acetaminophen: 1000 Tablet In 1 Bottle, Plastic (0536-1327-10)",250,RC,0536-1327-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Regular Strength Antacid/Antigas: 355 Ml In 1 Bottle (0536-1317-83),250,RC,0536-1317-83,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Carbonate 10 Gr (648 Mg) (Antacid): 1000 Tablet In 1 Bottle, Plastic (0536-1206-10)",250,RC,0536-1206-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)",250,RC,0536-1228-58,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)",250,RC,0536-1228-58,NDC,,,facility,both,1,EA,,4.58,4.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Regular Strength: 1 Bottle, Plastic In 1 Carton (0536-1232-01)  / 100 Tablet, Delayed Release In 1 Bottle, Plastic",250,RC,0536-1232-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Regular Strength: 1 Bottle, Plastic In 1 Carton (0536-1232-01)  / 100 Tablet, Delayed Release In 1 Bottle, Plastic",250,RC,0536-1232-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose: 1 Bottle, Plastic In 1 Carton (0536-1234-41)  / 120 Tablet, Delayed Release In 1 Bottle, Plastic",250,RC,0536-1234-41,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose: 1 Bottle, Plastic In 1 Carton (0536-1234-41)  / 120 Tablet, Delayed Release In 1 Bottle, Plastic",250,RC,0536-1234-41,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chlorode Hypertonicity Ophthalmic Solution: 1 Bottle In 1 Carton (0536-1254-94)  / 15 Ml In 1 Bottle,250,RC,0536-1254-94,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chlorode Hypertonicity Ophthalmic Solution: 1 Bottle In 1 Carton (0536-1254-94)  / 15 Ml In 1 Bottle,250,RC,0536-1254-94,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Anti-Itch: 212 G In 1 Bottle, Pump (0536-1268-12)",250,RC,0536-1268-12,NDC,,,facility,both,1,EA,,7.38,7.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Anti-Itch: 212 G In 1 Bottle, Pump (0536-1268-12)",250,RC,0536-1268-12,NDC,,,facility,both,1,EA,,7.38,7.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)",250,RC,0536-1286-36,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)",250,RC,0536-1286-36,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0536-1303-53,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infants: 1 Bottle, Dropper In 1 Carton (0536-1303-75)  / 30 Ml In 1 Bottle, Dropper",250,RC,0536-1303-75,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Zinc Oxide 20%: 72 Tube In 1 Case (0536-1316-28)  / 30 G In 1 Tube,250,RC,0536-1316-28,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Zinc Oxide 20%: 72 Tube In 1 Case (0536-1316-28)  / 30 G In 1 Tube,250,RC,0536-1316-28,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Regular Strength Antacid/Antigas: 355 Ml In 1 Bottle (0536-1317-83),250,RC,0536-1317-83,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rugby Hemorrhoidal: 12 Blister Pack In 1 Carton (0536-1186-12)  / 1 Suppository In 1 Blister Pack,250,RC,0536-1186-12,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Papaverine Hydrochloride: 25 Vial In 1 Carton (0517-4002-25)  / 2 Ml In 1 Vial (0517-4002-01),250,RC,0517-4002-25,NDC,,,facility,both,1,EA,,26.22,26.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cresemba: 2 Blister Pack In 1 Carton (0469-0520-02)  / 7 Capsule In 1 Blister Pack,250,RC,0469-0520-02,NDC,,,facility,both,1,EA,,165.28,165.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Myrbetriq: 1 Bottle In 1 Carton (0469-2601-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle",250,RC,0469-2601-30,NDC,,,facility,both,1,EA,,27.74,27.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Myrbetriq: 1 Bottle In 1 Carton (0469-2602-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle",250,RC,0469-2602-30,NDC,,,facility,both,1,EA,,27.74,27.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Myrbetriq: 1 Bottle In 1 Carton (0469-2602-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle",250,RC,0469-2602-30,NDC,,,facility,both,1,EA,,27.74,27.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyloy: 1 Vial In 1 Box (0469-3425-10)  / 5 Ml In 1 Vial,250,RC,0469-3425-10,NDC,,,facility,both,1,EA,,3136,3136,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyloy: 1 Vial In 1 Box (0469-4425-30)  / 15 Ml In 1 Vial,250,RC,0469-4425-30,NDC,,,facility,both,1,EA,,9408,9408,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Antifungal: 1 TUBE in 1 CARTON (0472-0735-56)  / 28 g in 1 TUBE,250,RC,0472-0735-56,NDC,,,facility,both,1,EA,,4.24,4.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Antifungal: 1 TUBE in 1 CARTON (0472-0735-56)  / 28 g in 1 TUBE,250,RC,0472-0735-56,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0472-1915-01,NDC,,,facility,both,1,EA,,7.98,7.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0472-1915-01,NDC,,,facility,both,1,EA,,7.98,7.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avycaz: 10 Vial, Single-Dose In 1 Carton (0456-2700-10)  / 1 Powder, For Solution In 1 Vial, Single-Dose (0456-2700-01)",250,RC,0456-2700-10,NDC,,,facility,both,1,EA,,178.29,178.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0456-0600-01,NDC,,,facility,both,1,EA,,6.13,6.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Viibryd: 30 Tablet In 1 Bottle (0456-1110-30),250,RC,0456-1110-30,NDC,,,facility,both,1,EA,,21.45,21.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Viibryd: 30 Tablet In 1 Bottle (0456-1120-30),250,RC,0456-1120-30,NDC,,,facility,both,1,EA,,21.9,21.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1201-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1201-30,NDC,,,facility,both,1,EA,,32.93,32.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1201-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1201-30,NDC,,,facility,both,1,EA,,33.84,33.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1202-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1202-30,NDC,,,facility,both,1,EA,,34.21,34.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1202-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1202-30,NDC,,,facility,both,1,EA,,33.81,33.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1203-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1203-30,NDC,,,facility,both,1,EA,,32.58,32.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1203-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1203-30,NDC,,,facility,both,1,EA,,33.74,33.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bystolic: 30 Tablet In 1 Bottle (0456-1405-30),250,RC,0456-1405-30,NDC,,,facility,both,1,EA,,10.52,10.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fetzima: 30 Capsule, Extended Release In 1 Bottle, Plastic (0456-2220-30)",250,RC,0456-2220-30,NDC,,,facility,both,1,EA,,31.69,31.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0456-2700-01,NDC,,,facility,both,1,EA,,177.81,177.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3565-01),250,RC,0480-3565-01,NDC,,,facility,both,1,EA,,5.79,5.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (0487-0201-01)  / 1 Vial, Single-Use In 1 Pouch / 3 Ml In 1 Vial, Single-Use",250,RC,0487-0201-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 25 Vial, Glass In 1 Tray (0517-1001-25)  / 1 Ml In 1 Vial, Glass (0517-1001-01)",250,RC,0517-1001-25,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial,250,RC,0517-1820-01,NDC,,,facility,both,1,EA,,168.04,168.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-2051-01,NDC,,,facility,both,1,EA,,43.33,43.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-2310-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-2310-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 5 Vial, Single-Dose In 1 Box (0517-2310-05)  / 10 Ml In 1 Vial, Single-Dose (0517-2310-01)",250,RC,0517-2310-05,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose",250,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose",250,RC,0517-2340-10,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-0901-01,NDC,,,facility,both,1,EA,,6.69,6.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-9158-31,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Asthmanefrin: 30 Pouch In 1 Carton (0487-2784-01)  / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use",250,RC,0487-2784-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"S2: 30 Pouch In 1 Carton (0487-5901-99)  / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use",250,RC,0487-5901-99,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"S2: 30 Pouch In 1 Carton (0487-5901-99)  / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use",250,RC,0487-5901-99,NDC,,,facility,both,1,EA,,3.48,3.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0487-9301-33,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",250,RC,0487-9501-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",250,RC,0487-9501-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 6 Pouch In 1 Carton (0487-9601-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,250,RC,0487-9601-01,NDC,,,facility,both,1,EA,,7.69,7.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 6 Pouch In 1 Carton (0487-9701-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,250,RC,0487-9701-01,NDC,,,facility,both,1,EA,,16.82,16.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01)  / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose",250,RC,0487-9801-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01)  / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose",250,RC,0487-9801-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0517-0031-01,NDC,,,facility,both,1,EA,,11.03,11.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fomepizole: 1 Vial In 1 Carton (0517-0710-01)  / 1.5 Ml In 1 Vial,250,RC,0517-0710-01,NDC,,,facility,both,1,EA,,10.1,10.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Folic Acid: 100 Tablet In 1 Bottle (53746-361-01),250,RC,53746-361-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0832-7123-89,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0832-7124-01)  / 1 Tablet, Delayed Release In 1 Blister Pack (0832-7124-89)",250,RC,0832-7124-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0944-0495-06,NDC,,,facility,both,1,EA,,10.86,10.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0944-0495-06,NDC,,,facility,both,1,EA,,22.6,22.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06),250,RC,0944-0495-05,NDC,,,facility,both,1,EA,,23.96,23.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06),250,RC,0944-0495-05,NDC,,,facility,both,1,EA,,62.23,62.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Blister Pack In 1 Carton (0904-7728-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7728-61,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Blister Pack In 1 Carton (0904-7728-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7728-61,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7914-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7914-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Pd-2 With Dextrose: 1000 Ml In 1 Bag (0941-0411-05),250,RC,0941-0411-05,NDC,,,facility,both,1,EA,,16.1,16.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Pd-2 With Dextrose: 2000 Ml In 1 Bag (0941-0411-06),250,RC,0941-0411-06,NDC,,,facility,both,1,EA,,39.2,39.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Pd-2 With Dextrose: 1000 Ml In 1 Bag (0941-0413-05),250,RC,0941-0413-05,NDC,,,facility,both,1,EA,,19.6,19.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Pd-2 With Dextrose: 1000 Ml In 1 Bag (0941-0415-05),250,RC,0941-0415-05,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0424-53),250,RC,0941-0424-53,NDC,,,facility,both,1,EA,,19.5,19.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0427-53),250,RC,0941-0427-53,NDC,,,facility,both,1,EA,,24.5,24.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0430-53),250,RC,0941-0430-53,NDC,,,facility,both,1,EA,,19.53,19.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0433-53),250,RC,0941-0433-53,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03),250,RC,0944-0493-01,NDC,,,facility,both,1,EA,,56.72,56.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0944-0493-03,NDC,,,facility,both,1,EA,,61.53,61.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Blister Pack In 1 Carton (0904-7511-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7511-61,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0955-1004-01,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 20 Pouch In 1 Case (0990-7923-36)  / 4 Bag In 1 Pouch / 50 Ml In 1 Bag,250,RC,0990-7923-36,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Pouch In 1 Case (0990-7935-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,250,RC,0990-7935-19,NDC,,,facility,both,1,EA,,18.13,18.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 Pouch In 1 Case (0990-7953-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag,250,RC,0990-7953-02,NDC,,,facility,both,1,EA,,9,9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 12 Pouch In 1 Case (0990-7973-05)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,250,RC,0990-7973-05,NDC,,,facility,both,1,EA,,15.68,15.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Pouch In 1 Case (0990-7983-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag,250,RC,0990-7983-02,NDC,,,facility,both,1,EA,,9.57,9.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 60 BAG in 1 CASE (0990-7984-11)  / 100 mL in 1 BAG,250,RC,0990-7984-11,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 48 Pouch In 1 Case (0990-7984-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,0990-7984-23,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 Pouch In 1 Case (0990-7984-36)  / 4 Bag In 1 Pouch / 50 Ml In 1 Bag,250,RC,0990-7984-36,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 12 Pouch In 1 Case (0990-7990-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,250,RC,0990-7990-09,NDC,,,facility,both,1,EA,,10.41,10.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 18 Pouch In 1 Case (0990-7983-55)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,250,RC,0990-7983-55,NDC,,,facility,both,1,EA,,11.11,11.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Pouch In 1 Case (0990-7922-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,250,RC,0990-7922-03,NDC,,,facility,both,1,EA,,9.65,9.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0955-1006-01,NDC,,,facility,both,1,EA,,3.38,3.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sevelamer Hydrochloride: 180 Tablet, Film Coated In 1 Bottle (0955-1048-18)",250,RC,0955-1048-18,NDC,,,facility,both,1,EA,,10.84,10.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0955-1052-01,NDC,,,facility,both,1,EA,,17.09,17.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0955-1052-01,NDC,,,facility,both,1,EA,,17.08,17.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0955-1054-01,NDC,,,facility,both,1,EA,,17.1,17.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 24 Bottle, Plastic In 1 Case (0990-6138-22)  / 250 Ml In 1 Bottle, Plastic",250,RC,0990-6138-22,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Pouch In 1 Case (0990-7074-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,0990-7074-26,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Pouch In 1 Case (0990-7075-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,0990-7075-26,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 12 Bottle, Plastic In 1 Case (0990-7139-09)  / 1000 Ml In 1 Bottle, Plastic",250,RC,0990-7139-09,NDC,,,facility,both,1,EA,,9.51,9.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0990-7715-12,NDC,,,facility,both,1,EA,,7.39,7.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0990-7715-13,NDC,,,facility,both,1,EA,,22.99,22.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0990-7715-13,NDC,,,facility,both,1,EA,,3.31,3.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 Pouch In 1 Case (0990-7730-37)  / 4 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,0990-7730-37,NDC,,,facility,both,1,EA,,5.72,5.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Pouch In 1 Case (0990-7918-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,250,RC,0990-7918-19,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Blister Pack In 1 Carton (0904-7511-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7511-61,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cetirizine: 100 Blister Pack In 1 Carton (0904-7510-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7510-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7246-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7246-68,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7246-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7246-68,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7247-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7247-68,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7247-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7247-68,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7252-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7252-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sennosides: 1000 Tablet, Film Coated In 1 Bottle (0904-7252-80)",250,RC,0904-7252-80,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sennosides: 1000 Tablet, Film Coated In 1 Bottle (0904-7252-80)",250,RC,0904-7252-80,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7257-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7257-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7257-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7257-61,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Bicarbonate: 10 Blister Pack In 1 Box, Unit-Dose (0904-7261-61)  / 10 Tablet In 1 Blister Pack",250,RC,0904-7261-61,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxcarbazepine: 100 Blister Pack In 1 Carton (0904-7263-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7263-61,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-7265-41,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-7276-41,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-7276-41,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7245-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7245-68,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7244-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7244-68,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7244-68)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7244-68,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7187-61,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 50 Blister Pack In 1 Carton (0904-7193-06)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7193-06,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 100 Blister Pack In 1 Carton (0904-7214-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7214-61,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7219-61)  / 1 Capsule, Extended Release In 1 Blister Pack",250,RC,0904-7219-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7227-61,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7227-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-7237-60),250,RC,0904-7237-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61)  / 10 Capsule In 1 Blister Pack",250,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61)  / 10 Capsule In 1 Blister Pack",250,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7243-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7243-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-7279-66,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-7279-66,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benztropine Mesylate: 100 Blister Pack In 1 Carton (0904-7288-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7288-61,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7383-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol: 100 Blister Pack In 1 Carton (0904-7391-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7391-61,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (0904-7418-44)",250,RC,0904-7418-44,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Major Nasal Decongestant: 1 Bottle, Pump In 1 Carton (0904-7427-30)  / 30 Ml In 1 Bottle, Pump",250,RC,0904-7427-30,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Major Nasal Decongestant: 1 Bottle, Pump In 1 Carton (0904-7427-30)  / 30 Ml In 1 Bottle, Pump",250,RC,0904-7427-30,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7442-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7442-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Acetaminophen: 1 Bottle In 1 Carton (0904-7445-20)  / 118 Ml In 1 Bottle,250,RC,0904-7445-20,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atovaquone: 5 Ml In 1 Cup, Unit-Dose (0904-7459-41)",250,RC,0904-7459-41,NDC,,,facility,both,1,EA,,39.23,39.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atovaquone: 5 Ml In 1 Cup, Unit-Dose (0904-7459-41)",250,RC,0904-7459-41,NDC,,,facility,both,1,EA,,39.89,39.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7501-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7501-61,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7501-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7501-61,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7505-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7505-61,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7505-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7505-61,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-7509-30)  / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-7509-30,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-7509-30)  / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-7509-30,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cetirizine: 100 Blister Pack In 1 Carton (0904-7510-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7510-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7383-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,10019-120-39,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7375-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7375-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7293-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7293-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7293-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7293-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7305-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7305-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7308-61,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7308-61,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 50 Blister Pack In 1 Carton (0904-7350-06)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7350-06,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7355-04)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7355-04,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7356-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7356-61,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7360-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7360-61,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7360-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7360-61,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7362-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7362-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7363-61,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7363-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7375-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7375-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7187-61,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-009-01)",250,RC,13668-009-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-009-01)",250,RC,13668-009-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (13668-104-01)",250,RC,13668-104-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (13668-104-01)",250,RC,13668-104-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (13668-105-01)",250,RC,13668-105-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Losartan Potassium: 90 TABLET in 1 BOTTLE (13668-113-90) ,250,RC,13668-113-90,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (13668-190-30)",250,RC,13668-190-30,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Minocycline Hydrochloride: 50 Capsule In 1 Bottle (13668-484-50),250,RC,13668-484-50,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tadalafil: 30 Tablet In 1 Bottle (13668-581-30),250,RC,13668-581-30,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-706-10)",250,RC,13811-706-10,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-706-10)",250,RC,13811-706-10,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-707-10)",250,RC,13811-707-10,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isoproterenol Hydrochloride: 10 Vial, Single-Dose In 1 Carton (14789-011-01)  / 1 Ml In 1 Vial, Single-Dose",250,RC,14789-011-01,NDC,,,facility,both,1,EA,,175.83,175.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (13668-190-30)",250,RC,13668-190-30,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",250,RC,13533-800-71,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",250,RC,13533-800-24,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",250,RC,13533-800-24,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",250,RC,13533-800-71,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Nitroprusside: 1 Vial, Glass In 1 Carton (14789-012-02)  / 2 Ml In 1 Vial, Glass",250,RC,14789-012-02,NDC,,,facility,both,1,EA,,124.57,124.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",250,RC,13533-800-24,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,14789-108-16,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-016-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-026-01,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-036-01,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (16714-041-10),250,RC,16714-041-10,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (16714-041-10),250,RC,16714-041-10,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-048-01)",250,RC,16714-048-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (16714-055-01)  / 15 G In 1 Tube,250,RC,16714-055-01,NDC,,,facility,both,1,EA,,204.56,204.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (16714-081-10),250,RC,16714-081-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (16714-081-10),250,RC,16714-081-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clobazam: 1 Bottle, Glass In 1 Carton (16714-087-01)  / 120 Ml In 1 Bottle, Glass",250,RC,16714-087-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (16714-110-01)",250,RC,16714-110-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (16714-110-01)",250,RC,16714-110-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-049-01)",250,RC,16714-049-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,16714-006-01,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levocarnitine: 9 Blister Pack In 1 Carton (16571-762-09)  / 10 Tablet In 1 Blister Pack,250,RC,16571-762-09,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,14789-109-16,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Papaverine Hydrochloride: 10 Vial, Single-Use In 1 Carton (14789-121-05)  / 2 Ml In 1 Vial, Single-Use (14789-121-07)",250,RC,14789-121-05,NDC,,,facility,both,1,EA,,30.08,30.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenobarbital Sodium: 10 Vial, Glass In 1 Carton (14789-128-05)  / 1 Ml In 1 Vial, Glass (14789-128-07)",250,RC,14789-128-05,NDC,,,facility,both,1,EA,,36.55,36.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,14789-128-07,NDC,,,facility,both,1,EA,,30.58,30.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),250,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),250,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Tablet In 1 Bottle (16571-664-01),250,RC,16571-664-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 100 Tablet In 1 Bottle (16571-668-01),250,RC,16571-668-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 100 Tablet In 1 Bottle (16571-671-01),250,RC,16571-671-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 100 Tablet In 1 Bottle (16571-673-01),250,RC,16571-673-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa And Entacapone: 100 Tablet, Film Coated In 1 Bottle (16571-691-01)",250,RC,16571-691-01,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa And Entacapone: 100 Tablet, Film Coated In 1 Bottle (16571-693-01)",250,RC,16571-693-01,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamylon: 1 Tube In 1 Carton (16571-723-60)  / 56.7 G In 1 Tube,250,RC,16571-723-60,NDC,,,facility,both,1,EA,,130.37,130.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)",250,RC,10572-302-01,NDC,,,facility,both,1,EA,,35.28,35.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)",250,RC,10572-302-01,NDC,,,facility,both,1,EA,,32.91,32.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (10702-100-01),250,RC,10702-100-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (10702-100-01),250,RC,10702-100-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin Chloride: 100 Tablet In 1 Bottle, Plastic (10702-201-01)",250,RC,10702-201-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (10702-237-01),250,RC,10702-237-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"MONSELS SOLUTION: 8 g in 1 BOTTLE, GLASS (10481-0112-8) ",250,RC,10481-0112-8,NDC,,,facility,both,1,EA,,35.08,35.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Critic Aid Clear Af: 57 G In 1 Tube (11701-067-23),250,RC,11701-067-23,NDC,,,facility,both,1,EA,,12.34,12.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyanokit: 1 VIAL, GLASS in 1 CARTON (11704-370-01)  / 250 mL in 1 VIAL, GLASS",250,RC,11704-370-01,NDC,,,facility,both,1,EA,,1414.07,1414.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Grafco Applicator 15 Cm: 100 Stick In 1 Tube (12165-100-01),250,RC,12165-100-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silver Nitrate Applicators: 100 Applicator In 1 Vial (12870-0001-2)  / 100 Mg In 1 Applicator,250,RC,12870-0001-2,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)",250,RC,13107-001-30,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)",250,RC,13107-001-30,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-003-34)",250,RC,13107-003-34,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Critic Aid Clear Af: 57 G In 1 Tube (11701-067-23),250,RC,11701-067-23,NDC,,,facility,both,1,EA,,12.39,12.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Itraconazole: 150 Ml In 1 Bottle (10147-0150-1),250,RC,10147-0150-1,NDC,,,facility,both,1,EA,,69.74,69.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 90 Tablet In 1 Bottle (10135-787-90),250,RC,10135-787-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,10122-325-01,NDC,,,facility,both,1,EA,,129.93,129.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Curosurf: 1.5 Ml In 1 Vial, Glass (10122-510-01)",250,RC,10122-510-01,NDC,,,facility,both,1,EA,,871.35,871.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Curosurf: 3 Ml In 1 Vial, Glass (10122-510-03)",250,RC,10122-510-03,NDC,,,facility,both,1,EA,,1526.33,1526.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,10122-620-01,NDC,,,facility,both,1,EA,,34.67,34.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (10135-667-01),250,RC,10135-667-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (10135-672-99)  / 30 G In 1 Tube,250,RC,10135-672-99,NDC,,,facility,both,1,EA,,36.11,36.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Menthol And Zinc Oxide: 113 G In 1 Tube (10135-701-04),250,RC,10135-701-04,NDC,,,facility,both,1,EA,,4.66,4.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Menthol And Zinc Oxide: 113 G In 1 Tube (10135-701-04),250,RC,10135-701-04,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyrazinamide: 100 Tablet In 1 Bottle (10135-735-01),250,RC,10135-735-01,NDC,,,facility,both,1,EA,,6.46,6.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rifabutin: 100 Capsule In 1 Bottle (10135-738-01),250,RC,10135-738-01,NDC,,,facility,both,1,EA,,8.39,8.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (10135-779-01),250,RC,10135-779-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 90 Tablet In 1 Bottle (10135-787-90),250,RC,10135-787-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 100 Tablet In 1 Bottle (13107-014-01),250,RC,13107-014-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 100 Tablet In 1 Bottle (13107-014-01),250,RC,13107-014-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-031-34)",250,RC,13107-031-34,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",250,RC,13533-800-20,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",250,RC,13533-800-20,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",250,RC,13533-800-20,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-031-34)",250,RC,13107-031-34,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 30 Tablet, Film Coated In 1 Bottle (13107-154-30)",250,RC,13107-154-30,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 30 Tablet, Film Coated In 1 Bottle (13107-154-30)",250,RC,13107-154-30,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diazoxide: 1 Bottle, Dropper In 1 Carton (13517-100-30)  / 30 Ml In 1 Bottle, Dropper",250,RC,13517-100-30,NDC,,,facility,both,1,EA,,10.4,10.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (13517-628-01)",250,RC,13517-628-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50),250,RC,13533-318-05,NDC,,,facility,both,1,EA,,421.99,421.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hypertet: 1 Syringe, Glass In 1 Box (13533-634-02)  / 1 Ml In 1 Syringe, Glass (13533-634-20)",250,RC,13533-634-02,NDC,,,facility,both,1,EA,,1029.98,1029.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,13533-634-20,NDC,,,facility,both,1,EA,,898.61,898.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",250,RC,13533-800-12,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61)  / 10 Capsule, Liquid Filled In 1 Blister Pack",250,RC,0904-7183-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Major Regular Strength Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0904-6412-92)",250,RC,0904-6412-92,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Major Regular Strength Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0904-6412-92)",250,RC,0904-6412-92,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6418-61,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6418-61,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6426-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6426-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Temazepam: 30 Blister Pack In 1 Carton (0904-6436-04)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6436-04,NDC,,,facility,both,1,EA,,5.07,5.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel: 20 Blister Pack In 1 Carton (0904-6467-10)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6467-10,NDC,,,facility,both,1,EA,,9.55,9.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6475-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6475-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 100 Blister Pack In 1 Carton (0904-6477-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6477-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 100 Blister Pack In 1 Carton (0904-6477-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6477-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Major Lubrifresh Pm: 1 Tube In 1 Carton (0904-6488-38)  / 3.5 G In 1 Tube,250,RC,0904-6488-38,NDC,,,facility,both,1,EA,,8.24,8.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 100 Blister Pack In 1 Carton (0904-6500-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6500-61,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel: 30 Blister Pack In 1 Carton (0904-6467-07)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6467-07,NDC,,,facility,both,1,EA,,13.15,13.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61)  / 10 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6407-61,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61)  / 10 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6407-61,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6351-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6351-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6351-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6351-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6352-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6352-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6352-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6352-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6353-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6353-61,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6353-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6353-61,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6359-61)",250,RC,0904-6359-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6360-61)",250,RC,0904-6360-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6369-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6369-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6373-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6373-61,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6373-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6373-61,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6374-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6374-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6374-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6374-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 100 Blister Pack In 1 Carton (0904-6377-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6377-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 100 Blister Pack In 1 Carton (0904-6377-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6377-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 100 Blister Pack In 1 Carton (0904-6501-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6501-61,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6322-61,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 100 Blister Pack In 1 Carton (0904-6501-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6501-61,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Blister Pack In 1 Carton (0904-6502-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6502-61,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6558-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6558-61,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 100 Blister Pack In 1 Carton (0904-6565-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6565-61,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 100 Blister Pack In 1 Carton (0904-6565-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6565-61,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6570-61,NDC,,,facility,both,1,EA,,2.24,2.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6570-61,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 100 Blister Pack In 1 Carton (0904-6575-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6575-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6558-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6558-61,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-6624-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6624-61,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6637-61,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6637-61,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6638-61,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6638-61,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6640-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6640-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6557-61,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6557-61,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6503-61,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6503-61,NDC,,,facility,both,1,EA,,3.44,3.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6505-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6505-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6505-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6505-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6506-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6506-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6506-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6506-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meclizine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6516-61)  / 1 TABLET in 1 BLISTER PACK,250,RC,0904-6516-61,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meclizine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6516-61)  / 1 TABLET in 1 BLISTER PACK,250,RC,0904-6516-61,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 100 Blister Pack In 1 Carton (0904-6519-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6519-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 100 Blister Pack In 1 Carton (0904-6519-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6519-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Senna-Lax: 10 Blister Pack In 1 Box (0904-6522-61)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6522-61,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propranolol Hydrochloride: 100 Blister Pack In 1 Carton (0904-6550-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6550-61,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 100 Blister Pack In 1 Carton (0904-6552-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6552-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 30 Blister Pack In 1 Carton (0904-6553-04)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6553-04,NDC,,,facility,both,1,EA,,6.86,6.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 30 Blister Pack In 1 Carton (0904-6553-04)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6553-04,NDC,,,facility,both,1,EA,,7.56,7.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Blister Pack In 1 Carton (0904-6502-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6502-61,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6322-61,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 50 Blister Pack In 1 Carton (0904-6322-06)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6322-06,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pentoxifylline: 100 Blister Pack In 1 Carton (0904-5448-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-5448-61,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-5522-61,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-5522-61,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxazosin: 100 Blister Pack In 1 Carton (0904-5524-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-5524-61,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heartburn Relief Original Strength: 1 Bottle In 1 Carton (0904-5529-52)  / 60 Tablet, Film Coated In 1 Bottle",250,RC,0904-5529-52,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heartburn Relief Original Strength: 30 Blister Pack In 1 Carton (0904-5529-87)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5529-87,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heartburn Relief Original Strength: 30 Blister Pack In 1 Carton (0904-5529-87)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5529-87,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5676-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5676-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pentoxifylline: 100 Blister Pack In 1 Carton (0904-5448-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-5448-61,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5677-61,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Blister Pack In 1 Carton (0904-5784-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-5784-61,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-5789-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-5789-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 500 Tablet In 1 Bottle (0904-5853-40),250,RC,0904-5853-40,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 500 Tablet In 1 Bottle (0904-5853-40),250,RC,0904-5853-40,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (0904-5853-60),250,RC,0904-5853-60,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5677-61,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acid Gone Antacid Extra Strength: 100 Tablet, Chewable In 1 Bottle (0904-5365-60)",250,RC,0904-5365-60,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Banophen: 100 Capsule In 1 Bottle (0904-5307-60),250,RC,0904-5307-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0832-7124-01)  / 1 Tablet, Delayed Release In 1 Blister Pack (0832-7124-89)",250,RC,0832-7124-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oil: 473 Ml In 1 Bottle, Plastic (0869-0831-43)",250,RC,0869-0831-43,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oil: 473 Ml In 1 Bottle, Plastic (0869-0831-43)",250,RC,0869-0831-43,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bismatrol: 236 mL in 1 BOTTLE (0904-1313-09) ,250,RC,0904-1313-09,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bismatrol: 236 mL in 1 BOTTLE (0904-1313-09) ,250,RC,0904-1313-09,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-2056-61)  / 10 Capsule In 1 Blister Pack,250,RC,0904-2056-61,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)",250,RC,0904-2533-21,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)",250,RC,0904-2533-21,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-2725-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-2725-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Blister Pack In 1 Carton (0904-3854-61)  / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-3854-61,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Blister Pack In 1 Carton (0904-3854-61)  / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-3854-61,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-3865-75,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-3865-75,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sudogest: 1 Bottle, Plastic In 1 Carton (0904-5053-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic",250,RC,0904-5053-59,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (0904-5853-60),250,RC,0904-5853-60,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61)  / 1 Tablet In 1 Blister Pack",250,RC,0904-5891-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61)  / 1 Tablet In 1 Blister Pack",250,RC,0904-5891-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Blister Pack In 1 Carton (0904-6085-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6085-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbamazepine: 100 Blister Pack In 1 Carton (0904-6172-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6172-61,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-6238-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6238-61,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ziprasidone: 80 Blister Pack In 1 Carton (0904-6269-45)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6269-45,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ziprasidone: 80 Blister Pack In 1 Carton (0904-6272-45)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6272-45,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6292-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6292-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 30 Blister Pack In 1 Carton (0904-6293-04)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6293-04,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel: 100 Blister Pack In 1 Carton (0904-6294-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6294-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)",250,RC,0904-6300-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)",250,RC,0904-6300-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6303-61)",250,RC,0904-6303-61,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sore Throat Cherry: 177 Ml In 1 Bottle, Spray (0904-6305-21)",250,RC,0904-6305-21,NDC,,,facility,both,1,EA,,3.47,3.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sore Throat Cherry: 177 Ml In 1 Bottle, Spray (0904-6305-21)",250,RC,0904-6305-21,NDC,,,facility,both,1,EA,,3.47,3.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 50 Blister Pack In 1 Carton (0904-6322-06)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6322-06,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6084-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6084-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6082-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61)  / 1 Tablet In 1 Blister Pack",250,RC,0904-5892-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61)  / 1 Tablet In 1 Blister Pack",250,RC,0904-5892-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"INFANTS GAS RELIEF: 1 BOTTLE, DROPPER in 1 CARTON (0904-5894-30)  / 30 mL in 1 BOTTLE, DROPPER",250,RC,0904-5894-30,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"INFANTS GAS RELIEF: 1 BOTTLE, DROPPER in 1 CARTON (0904-5894-30)  / 30 mL in 1 BOTTLE, DROPPER",250,RC,0904-5894-30,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-5921-61,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-5921-61,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-5959-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-5959-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (0904-6007-60),250,RC,0904-6007-60,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (0904-6007-60),250,RC,0904-6007-60,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6007-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6007-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Blister Pack In 1 Carton (0904-6008-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6008-61,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Blister Pack In 1 Carton (0904-6008-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6008-61,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6082-61,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61)  / 10 Capsule, Liquid Filled In 1 Blister Pack",250,RC,0904-7183-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6642-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7007-61,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7007-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7008-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7008-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 50 Blister Pack In 1 Carton (0904-7016-06)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7016-06,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 50 Blister Pack In 1 Carton (0904-7016-06)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7016-06,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-7027-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7027-61,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-7027-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7027-61,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naltrexone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7036-04)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7036-04,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Blister Pack In 1 Carton (0904-7041-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7041-61,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Blister Pack In 1 Carton (0904-7041-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7041-61,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 100 Blister Pack In 1 Carton (0904-7048-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7048-61,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxepin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7053-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7053-61,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7083-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7083-61,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7083-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7083-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naltrexone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7036-04)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7036-04,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7001-61,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7001-61,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6951-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6951-61,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6951-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6951-61,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6952-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6952-61,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6952-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6952-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6954-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6954-61,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6954-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6954-61,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6955-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6955-61,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6955-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6955-61,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6988-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6988-61,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6988-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6988-61,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-6992-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6992-61,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-6992-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6992-61,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-7000-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7000-61,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-7000-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7000-61,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7084-61,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7137-61,NDC,,,facility,both,1,EA,,3.19,3.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7137-61,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dronabinol: 100 Blister Pack In 1 Carton (0904-7144-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7144-61,NDC,,,facility,both,1,EA,,6.55,6.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 100 Blister Pack In 1 Carton (0904-7153-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7153-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7156-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7156-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluphenazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7158-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7158-61,NDC,,,facility,both,1,EA,,6.91,6.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7162-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Blister Pack In 1 Carton (0904-7172-07)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7172-07,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Blister Pack In 1 Carton (0904-7172-07)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7172-07,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Blister Pack In 1 Carton (0904-7177-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7177-61,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Blister Pack In 1 Carton (0904-7177-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7177-61,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Blister Pack In 1 Carton (0904-7178-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7178-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Blister Pack In 1 Carton (0904-7178-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7178-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7162-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7130-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7130-61,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Blister Pack In 1 Carton (0904-7126-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7126-61,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pioglitazone: 100 Blister Pack In 1 Carton (0904-7090-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7090-61,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pioglitazone: 100 Blister Pack In 1 Carton (0904-7090-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7090-61,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-7097-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7097-61,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Blister Pack In 1 Carton (0904-7105-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7105-61,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Blister Pack In 1 Carton (0904-7105-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7105-61,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Blister Pack In 1 Carton (0904-7106-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7106-61,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 50 Blister Pack In 1 Carton (0904-7119-06)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7119-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 50 Blister Pack In 1 Carton (0904-7119-06)  / 1 Capsule In 1 Blister Pack,250,RC,0904-7119-06,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7122-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7122-61,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7122-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7122-61,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7123-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7123-61,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7123-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7123-61,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7124-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7124-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Blister Pack In 1 Carton (0904-7126-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-7126-61,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7084-61,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6950-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6950-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6950-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6950-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pseudoephedrine Hydrochloride: 30 Tablet In 1 Bottle (0904-6728-46),250,RC,0904-6728-46,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61)  / 10 Tablet In 1 Blister Pack",250,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61)  / 10 Tablet In 1 Blister Pack",250,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nasal Decongestant: 1 Bottle, Spray In 1 Carton (0904-6761-30)  / 30 Ml In 1 Bottle, Spray",250,RC,0904-6761-30,NDC,,,facility,both,1,EA,,3.74,3.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Loratadine Oral: 1 Bottle In 1 Carton (0904-6767-20)  / 120 Ml In 1 Bottle,250,RC,0904-6767-20,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61)  / 10 Tablet In 1 Blister Pack",250,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61)  / 10 Tablet In 1 Blister Pack",250,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6778-61)  / 1 Tablet, Coated In 1 Blister Pack",250,RC,0904-6778-61,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6778-61)  / 1 Tablet, Coated In 1 Blister Pack",250,RC,0904-6778-61,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6782-61,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6782-61,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-6794-30)  / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-6794-30,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-6794-30)  / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-6794-30,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)",250,RC,0904-6794-80,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),250,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),250,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6665-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6665-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6666-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6666-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6667-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6667-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sildenafil: 50 Blister Pack In 1 Carton (0904-6671-06)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6671-06,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sildenafil: 50 Blister Pack In 1 Carton (0904-6671-06)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6671-06,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 40 Blister Pack In 1 Carton (0904-6681-08)  / 1 Capsule In 1 Blister Pack,250,RC,0904-6681-08,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 100 Blister Pack In 1 Carton (0904-6704-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6704-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 100 Blister Pack In 1 Carton (0904-6704-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6704-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6709-61,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6709-61,NDC,,,facility,both,1,EA,,1.87,1.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6718-39,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39)  / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6718-39,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)",250,RC,0904-6794-80,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6797-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6797-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6861-61)  / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6861-61,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6861-61)  / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6861-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 90 Blister Pack In 1 Carton (0904-6861-90)  / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6861-90,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6868-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6868-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6869-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6869-61,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pseudoephedrine Hydrochloride: 5 Blister Pack In 1 Box (0904-6907-06)  / 10 Tablet In 1 Blister Pack,250,RC,0904-6907-06,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6923-61,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6927-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6927-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86),250,RC,0904-6931-86,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86),250,RC,0904-6931-86,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6949-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6949-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6949-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6949-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61)  / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6860-61,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6642-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61)  / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6860-61,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6852-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6798-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6798-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6799-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6799-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6817-06)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6817-06,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6817-06)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6817-06,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6817-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6817-61,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6817-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6817-61,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6818-06)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6818-06,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-6828-05,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0904-6828-05,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 4 Tray In 1 Carton (0904-6828-94)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0904-6828-05)",250,RC,0904-6828-94,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 4 Tray In 1 Carton (0904-6828-94)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0904-6828-05)",250,RC,0904-6828-94,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 50 Blister Pack In 1 Carton (0904-6830-06)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6830-06,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 50 Blister Pack In 1 Carton (0904-6830-06)  / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6830-06,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61)  / 1 Tablet In 1 Blister Pack,250,RC,0904-6852-61,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Folic Acid: 100 Tablet In 1 Bottle (53746-361-01),250,RC,53746-361-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 100 Tablet In 1 Bottle (53746-511-01),250,RC,53746-511-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-859-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-862-11,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-862-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-907-11,NDC,,,facility,both,1,EA,,5.36,5.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-918-95,NDC,,,facility,both,1,EA,,5.35,5.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-928-95,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-964-95,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-968-11,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-968-11,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-975-11,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-975-11,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-988-33,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-988-33,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-928-95,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-844-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-844-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-697-11,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-698-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-698-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-728-11,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-750-95,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-755-11,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tizanidine: 30 Blister Pack In 1 Box, Unit-Dose (68084-775-25)  / 1 Tablet In 1 Blister Pack (68084-775-95)",250,RC,68084-775-25,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-775-95,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-775-95,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-776-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-776-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-782-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-782-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-805-11,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-808-11,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-808-11,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-655-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-001-59,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-762-59,NDC,,,facility,both,1,EA,,7.71,7.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Famotidine: 50 Ml In 1 Bottle (68180-150-01),250,RC,68180-150-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Famotidine: 50 Ml In 1 Bottle (68180-150-01),250,RC,68180-150-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-152-06)",250,RC,68180-152-06,NDC,,,facility,both,1,EA,,19.07,19.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-152-06)",250,RC,68180-152-06,NDC,,,facility,both,1,EA,,19.17,19.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68180-166-11,NDC,,,facility,both,1,EA,,4.52,4.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-756-59,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68180-166-11,NDC,,,facility,both,1,EA,,4.52,4.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 90 Tablet, Extended Release In 1 Bottle (68180-319-09)",250,RC,68180-319-09,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 90 Tablet, Extended Release In 1 Bottle (68180-319-09)",250,RC,68180-319-09,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cephalexin: 100 Ml In 1 Bottle (68180-441-01),250,RC,68180-441-01,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Quetiapine Fumarate: 1000 Tablet In 1 Bottle (68180-445-03),250,RC,68180-445-03,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine Succinate: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-593-06)",250,RC,68180-593-06,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline: 60 Ml In 1 Bottle (68180-657-01),250,RC,68180-657-01,NDC,,,facility,both,1,EA,,7.03,7.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ethambutol Hydrochloride: 100 Tablet In 1 Bottle (68180-280-01),250,RC,68180-280-01,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-756-59,NDC,,,facility,both,1,EA,,3.16,3.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-750-59,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-004-59,NDC,,,facility,both,1,EA,,4.53,4.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-004-59,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-048-59,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-048-59,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-049-59,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-129-59,NDC,,,facility,both,1,EA,,4.8,4.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-129-59,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-330-59,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-330-59,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 3 Tray In 1 Case (68094-330-62)  / 10 Cup, Unit-Dose In 1 Tray / 10.15 Ml In 1 Cup, Unit-Dose (68094-330-59)",250,RC,68094-330-62,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 3 Tray In 1 Case (68094-330-62)  / 10 Cup, Unit-Dose In 1 Tray / 10.15 Ml In 1 Cup, Unit-Dose (68094-330-59)",250,RC,68094-330-62,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-494-59,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-600-59,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-750-59,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68094-001-59,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-655-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-654-11,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-270-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-270-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-272-11,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-272-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-280-11,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-281-11,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-281-11,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-282-11,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-282-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-284-11,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-284-11,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-291-11,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-291-11,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-299-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-299-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-215-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-215-11)",250,RC,68084-215-01,NDC,,,facility,both,1,EA,,3.95,3.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-214-11,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-104-11,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-104-11,NDC,,,facility,both,1,EA,,3.33,3.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-120-11,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-120-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-149-11,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-149-11,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-155-11,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-157-11,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-157-11,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-202-11,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-204-11,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-204-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 10 Blister Pack In 1 Carton (68084-214-01)  / 10 Capsule In 1 Blister Pack (68084-214-11),250,RC,68084-214-01,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 10 Blister Pack In 1 Carton (68084-214-01)  / 10 Capsule In 1 Blister Pack (68084-214-11),250,RC,68084-214-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-214-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-309-11,NDC,,,facility,both,1,EA,,4.52,4.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-313-11,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-480-11,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-494-11,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-536-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-536-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-539-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-539-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-572-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-572-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-590-95,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-590-95,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Blister Pack In 1 Box, Unit-Dose (68084-597-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (68084-597-11)",250,RC,68084-597-01,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Blister Pack In 1 Box, Unit-Dose (68084-597-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (68084-597-11)",250,RC,68084-597-01,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-643-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-654-11,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-480-11,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oseltamivir Phosphate: 1 Bottle, Glass In 1 Carton (68180-678-01)  / 60 Ml In 1 Bottle, Glass",250,RC,68180-678-01,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-479-11,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-342-11,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-342-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-344-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-346-11,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-346-11,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-347-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-347-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-354-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-376-11,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-381-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-381-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-389-11,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-444-11,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-450-11,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-479-11,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (69097-098-08),250,RC,69097-098-08,NDC,,,facility,both,1,EA,,11.16,11.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Abacavir And Lamivudine: 30 Tablet, Film Coated In 1 Bottle (69097-362-02)",250,RC,69097-362-02,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle, Plastic (69097-387-02)",250,RC,69097-387-02,NDC,,,facility,both,1,EA,,75.27,75.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosfomycin Tromethamine: 1 Dose Pack In 1 Carton (69097-579-67)  / 1 Granule, For Solution In 1 Dose Pack",250,RC,69097-579-67,NDC,,,facility,both,1,EA,,86.32,86.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69097-708-31,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69097-846-07)",250,RC,69097-846-07,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 200 Capsule In 1 Bottle (69097-862-83),250,RC,69097-862-83,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 200 Capsule In 1 Bottle (69097-862-83),250,RC,69097-862-83,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 30 Tablet In 1 Bottle (69097-999-02),250,RC,69097-999-02,NDC,,,facility,both,1,EA,,11.15,11.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 1 Bottle In 1 Carton (69230-326-01)  / 100 Tablet, Film Coated In 1 Bottle",250,RC,69230-326-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 1 Bottle In 1 Carton (69230-326-01)  / 100 Tablet, Film Coated In 1 Bottle",250,RC,69230-326-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Bottle In 1 Carton (69238-1051-3)  / 30 Tablet In 1 Bottle,250,RC,69238-1051-3,NDC,,,facility,both,1,EA,,57.84,57.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",250,RC,68992-3040-3,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68516-5218-0,NDC,,,facility,both,1,EA,,26.34,26.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Budesonide: 30 Tablet, Extended Release In 1 Bottle (68682-309-30)",250,RC,68682-309-30,NDC,,,facility,both,1,EA,,62.07,62.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metronidazole: 1 Tube, With Applicator In 1 Carton (68682-455-70)  / 70 G In 1 Tube, With Applicator",250,RC,68682-455-70,NDC,,,facility,both,1,EA,,240.93,240.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Derma-Smoothe/Fs: 1 Bottle In 1 Carton (68791-102-04)  / 118.28 Ml In 1 Bottle,250,RC,68791-102-04,NDC,,,facility,both,1,EA,,59.45,59.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68968-3410-1,NDC,,,facility,both,1,EA,,13.66,13.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68968-3450-1,NDC,,,facility,both,1,EA,,12.94,12.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (69238-1069-1)",250,RC,69238-1069-1,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline Hyclate: 50 Capsule In 1 Bottle (69238-1100-2),250,RC,69238-1100-2,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)",250,RC,69315-306-15,NDC,,,facility,both,1,EA,,14.77,14.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 1 Bottle, Plastic In 1 Carton (69315-308-02)  / 2.5 Ml In 1 Bottle, Plastic",250,RC,69315-308-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (69315-904-01),250,RC,69315-904-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (69315-904-01),250,RC,69315-904-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (69315-905-01),250,RC,69315-905-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (69315-905-01),250,RC,69315-905-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 1000 Tablet In 1 Bottle (69315-905-10),250,RC,69315-905-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)",250,RC,69315-306-15,NDC,,,facility,both,1,EA,,14.77,14.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69339-153-01,NDC,,,facility,both,1,EA,,3.24,3.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69339-160-01,NDC,,,facility,both,1,EA,,6.65,6.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69339-174-02,NDC,,,facility,both,1,EA,,18.58,18.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Indocin: 30 Suppository In 1 Box (69344-102-33),250,RC,69344-102-33,NDC,,,facility,both,1,EA,,391.59,391.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Selenium Sulfide: 180 Ml In 1 Bottle (69367-229-18),250,RC,69367-229-18,NDC,,,facility,both,1,EA,,121.68,121.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle, Plastic (69367-349-60)",250,RC,69367-349-60,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69374-308-05,NDC,,,facility,both,1,EA,,7.2,7.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daraprim: 30 Tablet In 1 Bottle, Plastic (69413-330-30)",250,RC,69413-330-30,NDC,,,facility,both,1,EA,,1470,1470,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69339-136-03,NDC,,,facility,both,1,EA,,14.59,14.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Imipramine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69315-134-01)",250,RC,69315-134-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Tablet In 1 Bottle (69315-116-01),250,RC,69315-116-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metolazone: 100 Tablet In 1 Bottle (69292-564-01),250,RC,69292-564-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 30 Tablet In 1 Bottle (69238-1154-3),250,RC,69238-1154-3,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 30 Tablet In 1 Bottle (69238-1154-3),250,RC,69238-1154-3,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 100 Tablet In 1 Bottle (69238-1489-1),250,RC,69238-1489-1,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 100 Tablet In 1 Bottle (69238-1490-1),250,RC,69238-1490-1,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5)  / 15 G In 1 Tube,250,RC,69238-1532-5,NDC,,,facility,both,1,EA,,6.5,6.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5)  / 15 G In 1 Tube,250,RC,69238-1532-5,NDC,,,facility,both,1,EA,,7.14,7.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (69238-1540-1),250,RC,69238-1540-1,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (69238-1540-1),250,RC,69238-1540-1,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (69238-1544-1)",250,RC,69238-1544-1,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (69238-1544-1)",250,RC,69238-1544-1,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylergonovine Maleate: 28 Tablet In 1 Bottle (69238-1605-8),250,RC,69238-1605-8,NDC,,,facility,both,1,EA,,23.86,23.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 118 Ml In 1 Bottle (69238-2027-8),250,RC,69238-2027-8,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propranolol Hydrochloride: 100 Tablet In 1 Bottle (69238-2077-1),250,RC,69238-2077-1,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propranolol Hydrochloride: 100 Tablet In 1 Bottle (69238-2077-1),250,RC,69238-2077-1,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (69238-2512-9)  / 230 Ml In 1 Bottle, Glass",250,RC,69238-2512-9,NDC,,,facility,both,1,EA,,136.42,136.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (69238-2512-9)  / 230 Ml In 1 Bottle, Glass",250,RC,69238-2512-9,NDC,,,facility,both,1,EA,,92.47,92.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline Hyclate: 50 Capsule In 1 Bottle (69238-1100-2),250,RC,69238-1100-2,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68462-897-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-257-01)",250,RC,68382-257-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 30 Tablet In 1 Bottle (68382-297-06),250,RC,68382-297-06,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 30 Tablet In 1 Bottle (68382-297-06),250,RC,68382-297-06,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (68382-452-19)",250,RC,68382-452-19,NDC,,,facility,both,1,EA,,2.26,2.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (68382-452-19)",250,RC,68382-452-19,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68382-771-30,NDC,,,facility,both,1,EA,,9.24,9.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-257-01)",250,RC,68382-257-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68382-771-30,NDC,,,facility,both,1,EA,,6.23,6.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68382-772-30,NDC,,,facility,both,1,EA,,8.98,8.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68382-772-30,NDC,,,facility,both,1,EA,,8.75,8.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-805-01),250,RC,68382-805-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-805-01),250,RC,68382-805-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 500 Tablet In 1 Bottle (68382-805-05),250,RC,68382-805-05,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 500 Tablet In 1 Bottle (68382-805-05),250,RC,68382-805-05,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-806-01),250,RC,68382-806-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-256-01)",250,RC,68382-256-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-256-01)",250,RC,68382-256-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68180-877-71,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Jencycla: 1 Blister Pack In 1 Carton (68180-877-73)  / 28 Tablet In 1 Blister Pack,250,RC,68180-877-73,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68180-886-71,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Tablet In 1 Bottle (68180-981-01),250,RC,68180-981-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Tablet In 1 Bottle (68180-981-01),250,RC,68180-981-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 15 G In 1 Bottle, Plastic (68308-152-15)",250,RC,68308-152-15,NDC,,,facility,both,1,EA,,12.65,12.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 15 G In 1 Bottle, Plastic (68308-152-15)",250,RC,68308-152-15,NDC,,,facility,both,1,EA,,7.97,7.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atenolol: 100 Tablet In 1 Bottle (68382-022-01),250,RC,68382-022-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atenolol: 100 Tablet In 1 Bottle (68382-023-01),250,RC,68382-023-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meloxicam: 100 Tablet In 1 Bottle (68382-051-01),250,RC,68382-051-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)",250,RC,68382-092-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)",250,RC,68382-092-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 90 Tablet In 1 Bottle (68382-121-16),250,RC,68382-121-16,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 90 Tablet In 1 Bottle (68382-121-16),250,RC,68382-121-16,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (68382-180-01),250,RC,68382-180-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (68382-180-01),250,RC,68382-180-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68382-860-02,NDC,,,facility,both,1,EA,,23.5,23.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68382-910-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-333-90),250,RC,68462-333-90,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-333-90),250,RC,68462-333-90,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 1 BOTTLE, PLASTIC in 1 CARTON (68462-347-37)  / 30 mL in 1 BOTTLE, PLASTIC",250,RC,68462-347-37,NDC,,,facility,both,1,EA,,5.53,5.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Indomethacin: 100 Capsule In 1 Bottle (68462-406-01),250,RC,68462-406-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Indomethacin: 100 Capsule In 1 Bottle (68462-406-01),250,RC,68462-406-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acamprosate Calcium: 180 Tablet, Delayed Release In 1 Bottle (68462-435-18)",250,RC,68462-435-18,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 1 Tube In 1 Carton (68462-534-94)  / 100 G In 1 Tube,250,RC,68462-534-94,NDC,,,facility,both,1,EA,,481.97,481.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 15 G In 1 Tube (68462-564-17),250,RC,68462-564-17,NDC,,,facility,both,1,EA,,255.58,255.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 15 G In 1 Tube (68462-564-17),250,RC,68462-564-17,NDC,,,facility,both,1,EA,,255.58,255.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (68462-572-30)",250,RC,68462-572-30,NDC,,,facility,both,1,EA,,3.89,3.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (68462-572-30)",250,RC,68462-572-30,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68462-639-25,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68462-639-25,NDC,,,facility,both,1,EA,,3.75,3.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68462-720-84,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Epinephrine: 1 Vial, Multi-Dose In 1 Carton (68462-760-10)  / 10 Ml In 1 Vial, Multi-Dose",250,RC,68462-760-10,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68462-897-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
My Way: 1 Blister Pack In 1 Carton (68180-852-11)  / 1 Tablet In 1 Blister Pack,250,RC,68180-852-11,NDC,,,facility,both,1,EA,,18.77,18.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-330-90),250,RC,68462-330-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (68462-101-30),250,RC,68462-101-30,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zonisamide: 100 Capsule In 1 Bottle (68462-128-01),250,RC,68462-128-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zonisamide: 100 Capsule In 1 Bottle (68462-129-01),250,RC,68462-129-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 22 G In 1 Tube (68462-180-22),250,RC,68462-180-22,NDC,,,facility,both,1,EA,,11.13,11.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metronidazole: 1 Tube, With Applicator In 1 Carton (68462-184-49)  / 70 G In 1 Tube, With Applicator",250,RC,68462-184-49,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-255-01)",250,RC,68462-255-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-258-01)",250,RC,68462-258-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-260-01)",250,RC,68462-260-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-260-01)",250,RC,68462-260-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (68462-262-90)",250,RC,68462-262-90,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (68462-262-90)",250,RC,68462-262-90,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-292-01)",250,RC,68462-292-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-293-01)",250,RC,68462-293-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-293-01)",250,RC,68462-293-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Norethindrone Acetate: 50 Tablet In 1 Bottle (68462-304-50),250,RC,68462-304-50,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-330-90),250,RC,68462-330-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-099-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lansoprazole: 1 Kit In 1 Container (65628-080-10)  *  300 Ml In 1 Bottle, Plastic *  .9 G In 1 Bottle, Plastic",250,RC,65628-080-10,NDC,,,facility,both,1,EA,,10.55,10.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lansoprazole: 1 Kit In 1 Container (65628-080-10)  *  300 Ml In 1 Bottle, Plastic *  .9 G In 1 Bottle, Plastic",250,RC,65628-080-10,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Xifaxan: 30 Tablet In 1 Bottle (65649-301-03),250,RC,65649-301-03,NDC,,,facility,both,1,EA,,36.76,36.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Xifaxan: 60 Tablet In 1 Bottle (65649-303-02),250,RC,65649-303-02,NDC,,,facility,both,1,EA,,101,101,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03)  / 10 Tablet In 1 Blister Pack,250,RC,65649-303-03,NDC,,,facility,both,1,EA,,104.32,104.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03)  / 10 Tablet In 1 Blister Pack,250,RC,65649-303-03,NDC,,,facility,both,1,EA,,102.97,102.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diuril: 1 Bottle In 1 Carton (65649-311-12)  / 237 Ml In 1 Bottle,250,RC,65649-311-12,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02)  / .6 Ml In 1 Vial, Single-Dose",250,RC,65649-551-02,NDC,,,facility,both,1,EA,,169.33,169.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine Hydrochloride And Lidocaine Hydrochloride And Aluminum Hydroxide And Magnesium Hydro: 1 Kit In 1 Container (65628-050-01)  *  236 Ml In 1 Bottle, Plastic *  .2 G In 1 Bottle, Glass *  1.6 G In 1 Bottle, Glass",250,RC,65628-050-01,NDC,,,facility,both,1,EA,,9.53,9.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02)  / .6 Ml In 1 Vial, Single-Dose",250,RC,65649-551-02,NDC,,,facility,both,1,EA,,307.1,307.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (65862-006-01)",250,RC,65862-006-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (65862-006-01)",250,RC,65862-006-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 500 Tablet, Film Coated In 1 Bottle (65862-006-05)",250,RC,65862-006-05,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 500 Tablet, Film Coated In 1 Bottle (65862-006-05)",250,RC,65862-006-05,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cephalexin: 100 Capsule In 1 Bottle (65862-019-01),250,RC,65862-019-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cephalexin: 100 Capsule In 1 Bottle (65862-019-01),250,RC,65862-019-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,65862-021-06,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02)  / .6 Ml In 1 Vial, Single-Dose",250,RC,65649-551-02,NDC,,,facility,both,1,EA,,233.33,233.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine Hydrochloride And Lidocaine Hydrochloride And Aluminum Hydroxide And Magnesium Hydro: 1 Kit In 1 Container (65628-050-01)  *  236 Ml In 1 Bottle, Plastic *  .2 G In 1 Bottle, Glass *  1.6 G In 1 Bottle, Glass",250,RC,65628-050-01,NDC,,,facility,both,1,EA,,9.53,9.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-436-02,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-445-01,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-472-05,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-531-01,NDC,,,facility,both,1,EA,,20.6,20.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-535-01,NDC,,,facility,both,1,EA,,40.18,40.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-635-00,NDC,,,facility,both,1,EA,,2.24,2.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 25 Ampule In 1 Carton (65282-1605-1)  / 5 Ml In 1 Ampule,250,RC,65282-1605-1,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 25 Ampule In 1 Carton (65282-1605-1)  / 5 Ml In 1 Ampule,250,RC,65282-1605-1,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Savaysa: 30 Tablet, Film Coated In 1 Bottle (65597-203-30)",250,RC,65597-203-30,NDC,,,facility,both,1,EA,,26.43,26.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,65862-021-06,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-293-00,NDC,,,facility,both,1,EA,,6.58,6.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zidovudine: 240 Ml In 1 Bottle (65862-048-24),250,RC,65862-048-24,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)",250,RC,65862-373-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)",250,RC,65862-373-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,65862-390-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,65862-390-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01),250,RC,65862-419-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01),250,RC,65862-419-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Emtricitabine: 30 Capsule In 1 Bottle (65862-301-30),250,RC,65862-301-30,NDC,,,facility,both,1,EA,,22.87,22.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine Fumarate: 100 Tablet, Film Coated In 1 Bottle (65862-489-01)",250,RC,65862-489-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 473 Ml In 1 Bottle (65862-496-47),250,RC,65862-496-47,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)",250,RC,65862-503-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)",250,RC,65862-503-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (65862-503-20)",250,RC,65862-503-20,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (65862-503-20)",250,RC,65862-503-20,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-560-90)",250,RC,65862-560-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine Fumarate: 100 Tablet, Film Coated In 1 Bottle (65862-489-01)",250,RC,65862-489-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-246-08)",250,RC,65862-246-08,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-246-08)",250,RC,65862-246-08,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nevirapine: 240 Ml In 1 Bottle (65862-057-24),250,RC,65862-057-24,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (65862-096-20)",250,RC,65862-096-20,NDC,,,facility,both,1,EA,,6.75,6.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (65862-096-20)",250,RC,65862-096-20,NDC,,,facility,both,1,EA,,6.75,6.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 90 Tablet, Film Coated In 1 Bottle (65862-149-90)",250,RC,65862-149-90,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 90 Tablet, Film Coated In 1 Bottle (65862-149-90)",250,RC,65862-149-90,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Capsule In 1 Bottle (65862-192-01),250,RC,65862-192-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Capsule In 1 Bottle (65862-192-01),250,RC,65862-192-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Capsule In 1 Bottle (65862-193-01),250,RC,65862-193-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Capsule In 1 Bottle (65862-193-01),250,RC,65862-193-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 1000 Capsule In 1 Bottle (65862-193-99),250,RC,65862-193-99,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-201-90)",250,RC,65862-201-90,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-201-90)",250,RC,65862-201-90,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-202-90)",250,RC,65862-202-90,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-202-90)",250,RC,65862-202-90,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefdinir: 1 Bottle In 1 Carton (65862-218-60)  / 60 Ml In 1 Bottle,250,RC,65862-218-60,NDC,,,facility,both,1,EA,,5.12,5.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-022-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,65862-022-06,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-224-01,NDC,,,facility,both,1,EA,,6.84,6.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-662-01)",250,RC,64896-662-01,NDC,,,facility,both,1,EA,,7.51,7.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-663-01)",250,RC,64896-663-01,NDC,,,facility,both,1,EA,,7.51,7.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-663-01)",250,RC,64896-663-01,NDC,,,facility,both,1,EA,,7.51,7.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-664-01)",250,RC,64896-664-01,NDC,,,facility,both,1,EA,,9.35,9.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isoniazid: 100 Tablet In 1 Bottle (64950-217-10),250,RC,64950-217-10,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,64950-354-05,NDC,,,facility,both,1,EA,,8.34,8.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,64950-354-05,NDC,,,facility,both,1,EA,,8.7,8.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chloroquine Phosphate: 50 Tablet In 1 Bottle, Plastic (64980-177-50)",250,RC,64980-177-50,NDC,,,facility,both,1,EA,,4.42,4.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitriol: 1 Bottle, Glass In 1 Carton (64980-447-15)  / 15 Ml In 1 Bottle, Glass",250,RC,64980-447-15,NDC,,,facility,both,1,EA,,24.1,24.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Timolol Maleate: 1 Bottle In 1 Carton (64980-513-05)  / 5 Ml In 1 Bottle,250,RC,64980-513-05,NDC,,,facility,both,1,EA,,5.92,5.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Timolol Maleate: 1 Bottle In 1 Carton (64980-513-05)  / 5 Ml In 1 Bottle,250,RC,64980-513-05,NDC,,,facility,both,1,EA,,5.92,5.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Timolol Maleate: 1 Bottle In 1 Carton (64980-514-05)  / 5 Ml In 1 Bottle,250,RC,64980-514-05,NDC,,,facility,both,1,EA,,9.53,9.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Timolol Maleate: 1 Bottle In 1 Carton (64980-514-05)  / 5 Ml In 1 Bottle,250,RC,64980-514-05,NDC,,,facility,both,1,EA,,9.56,9.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ofloxacin: 1 Bottle, Plastic In 1 Carton (64980-515-05)  / 5 Ml In 1 Bottle, Plastic",250,RC,64980-515-05,NDC,,,facility,both,1,EA,,21.64,21.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ofloxacin: 1 Bottle, Plastic In 1 Carton (64980-515-05)  / 5 Ml In 1 Bottle, Plastic",250,RC,64980-515-05,NDC,,,facility,both,1,EA,,21.78,21.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-082-03)",250,RC,65162-082-03,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Itraconazole: 150 Ml In 1 Bottle, Glass (65162-087-74)",250,RC,65162-087-74,NDC,,,facility,both,1,EA,,35.52,35.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atomoxetine: 30 Capsule In 1 Bottle (64980-375-03),250,RC,64980-375-03,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (64850-511-01)",250,RC,64850-511-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (64850-502-01)",250,RC,64850-502-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrocortisone: 50 Tablet In 1 Bottle, Plastic (64380-970-25)",250,RC,64380-970-25,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrocortisone: 50 Tablet In 1 Bottle, Plastic (64380-970-25)",250,RC,64380-970-25,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,64679-465-50,NDC,,,facility,both,1,EA,,27.11,27.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
ENALAPRIL MALEATE: 100 TABLET in 1 BOTTLE (64679-923-02) ,250,RC,64679-923-02,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Colcrys: 100 Tablet, Film Coated In 1 Bottle, Plastic (64764-119-01)",250,RC,64764-119-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Colcrys: 100 Tablet, Film Coated In 1 Bottle, Plastic (64764-119-01)",250,RC,64764-119-01,NDC,,,facility,both,1,EA,,2.93,2.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitiza: 60 Capsule, Gelatin Coated In 1 Bottle (64764-240-60)",250,RC,64764-240-60,NDC,,,facility,both,1,EA,,11.16,11.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,64764-543-30,NDC,,,facility,both,1,EA,,24.63,24.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-720-30)",250,RC,64764-720-30,NDC,,,facility,both,1,EA,,30.98,30.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)",250,RC,64764-730-30,NDC,,,facility,both,1,EA,,30.5,30.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)",250,RC,64764-730-30,NDC,,,facility,both,1,EA,,30.42,30.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-750-30)",250,RC,64764-750-30,NDC,,,facility,both,1,EA,,30.97,30.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-750-30)",250,RC,64764-750-30,NDC,,,facility,both,1,EA,,30.47,30.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (64850-502-01)",250,RC,64850-502-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naproxen: 100 Tablet In 1 Bottle (65162-188-10),250,RC,65162-188-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naproxen: 100 Tablet In 1 Bottle (65162-188-10),250,RC,65162-188-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naproxen: 500 Tablet In 1 Bottle (65162-188-50),250,RC,65162-188-50,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-879-03)",250,RC,65162-879-03,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-880-03)",250,RC,65162-880-03,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ad First Aid Multipurpose: 1 Tube In 1 Box (65197-400-10)  / 42.5 G In 1 Tube,250,RC,65197-400-10,NDC,,,facility,both,1,EA,,5,5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ad First Aid Multipurpose: 1 Tube In 1 Box (65197-400-10)  / 42.5 G In 1 Tube,250,RC,65197-400-10,NDC,,,facility,both,1,EA,,5.01,5.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-052-09,NDC,,,facility,both,1,EA,,20.49,20.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Phosphates: 25 Vial, Single-Dose In 1 Tray (65219-052-29)  / 5 Ml In 1 Vial, Single-Dose (65219-052-09)",250,RC,65219-052-29,NDC,,,facility,both,1,EA,,20.58,20.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-119-01,NDC,,,facility,both,1,EA,,7.64,7.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-162-01,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-186-01,NDC,,,facility,both,1,EA,,8.2,8.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-188-01,NDC,,,facility,both,1,EA,,7.43,7.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketamine Hydrochloride: 10 Vial In 1 Tray (65219-188-10)  / 10 Ml In 1 Vial (65219-188-01),250,RC,65219-188-10,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-220-01,NDC,,,facility,both,1,EA,,5.67,5.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65219-222-01,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65162-791-04,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-560-90)",250,RC,65862-560-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65162-791-04,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Budesonide: 100 Capsule, Delayed Release In 1 Bottle (65162-778-10)",250,RC,65162-778-10,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (65162-282-03)",250,RC,65162-282-03,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sildenafil: 90 Tablet In 1 Bottle (65162-351-09),250,RC,65162-351-09,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sildenafil: 90 Tablet In 1 Bottle (65162-351-09),250,RC,65162-351-09,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10),250,RC,65162-464-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10),250,RC,65162-464-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10),250,RC,65162-465-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10),250,RC,65162-465-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (65162-676-84)  / 30 Ml In 1 Bottle, Spray",250,RC,65162-676-84,NDC,,,facility,both,1,EA,,36.17,36.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10),250,RC,65162-681-10,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10),250,RC,65162-681-10,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Escitalopram Oxalate: 240 Ml In 1 Bottle (65162-705-88),250,RC,65162-705-88,NDC,,,facility,both,1,EA,,6.21,6.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Escitalopram Oxalate: 240 Ml In 1 Bottle (65162-705-88),250,RC,65162-705-88,NDC,,,facility,both,1,EA,,6.45,6.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Guanfacine Hydrochloride: 100 Tablet In 1 Bottle (65162-711-10),250,RC,65162-711-10,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Extended Release In 1 Bottle (65162-757-10)",250,RC,65162-757-10,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Extended Release In 1 Bottle (65162-757-10)",250,RC,65162-757-10,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Budesonide: 100 Capsule, Delayed Release In 1 Bottle (65162-778-10)",250,RC,65162-778-10,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-099-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)",250,RC,65862-603-30,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-639-00,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Miacalcin: 1 Vial, Multi-Dose In 1 Carton (67457-675-02)  / 2 Ml In 1 Vial, Multi-Dose",250,RC,67457-675-02,NDC,,,facility,both,1,EA,,1023.74,1023.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-852-00,NDC,,,facility,both,1,EA,,7.96,7.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (67457-852-04)  / 4 Ml In 1 Vial, Single-Dose (67457-852-00)",250,RC,67457-852-04,NDC,,,facility,both,1,EA,,8.01,8.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-855-00,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 25 Vial In 1 Carton (67457-887-01)  / 1 Ml In 1 Vial (67457-887-00),250,RC,67457-887-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc: 12 Jar In 1 Case (67777-008-60)  / 425 G In 1 Jar (67777-008-61),250,RC,67777-008-60,NDC,,,facility,both,1,EA,,28.26,28.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc: 425.3 g in 1 JAR (67777-220-07) ,250,RC,67777-220-07,NDC,,,facility,both,1,EA,,33.15,33.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc: 425.3 g in 1 JAR (67777-220-07) ,250,RC,67777-220-07,NDC,,,facility,both,1,EA,,33.44,33.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 1 Vial In 1 Carton (67457-853-50)  / 5 Ml In 1 Vial,250,RC,67457-853-50,NDC,,,facility,both,1,EA,,36.14,36.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rocuronium Bromide: 10 VIAL, MULTI-DOSE in 1 CARTON (67457-574-10)  / 10 mL in 1 VIAL, MULTI-DOSE (67457-574-00) ",250,RC,67457-574-10,NDC,,,facility,both,1,EA,,7.25,7.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-426-00,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-433-00,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-437-00,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-438-00,NDC,,,facility,both,1,EA,,27.61,27.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vecuronium Bromide: 10 Vial In 1 Carton (67457-438-10)  / 10 Ml In 1 Vial (67457-438-00),250,RC,67457-438-10,NDC,,,facility,both,1,EA,,70.1,70.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-440-00,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron Hydrochloride: 25 VIAL, SINGLE-DOSE in 1 CARTON (67457-440-22)  / 2 mL in 1 VIAL, SINGLE-DOSE (67457-440-00) ",250,RC,67457-440-22,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rifampin: 1 Vial In 1 Carton (67457-445-60)  / 10 Ml In 1 Vial,250,RC,67457-445-60,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-475-00,NDC,,,facility,both,1,EA,,94.77,94.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Asclera: 2 Ml In 1 Ampule (67850-141-05),250,RC,67850-141-05,NDC,,,facility,both,1,EA,,29.28,29.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-422-00,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silver Sulfadiazine: 400 G In 1 Jar (67877-124-40),250,RC,67877-124-40,NDC,,,facility,both,1,EA,,104.76,104.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-198-90),250,RC,67877-198-90,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dronabinol: 60 Capsule In 1 Bottle (67877-753-60),250,RC,67877-753-60,NDC,,,facility,both,1,EA,,2.66,2.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose",250,RC,67919-030-01,NDC,,,facility,both,1,EA,,15.29,15.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride Extended-Release: 100 Tablet In 1 Bottle (68001-567-00),250,RC,68001-567-00,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride Extended-Release: 100 Tablet In 1 Bottle (68001-567-00),250,RC,68001-567-00,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oscimin: 100 Tablet, Orally Disintegrating In 1 Bottle (68047-253-01)",250,RC,68047-253-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oscimin: 100 Tablet, Orally Disintegrating In 1 Bottle (68047-253-01)",250,RC,68047-253-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-044-11,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-044-11,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-045-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-045-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-046-11,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,68084-046-11,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (67877-717-12)",250,RC,67877-717-12,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (67877-717-12)",250,RC,67877-717-12,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-198-90),250,RC,67877-198-90,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lansoprazole: 90 Capsule, Delayed Release In 1 Bottle (67877-275-90)",250,RC,67877-275-90,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Riluzole: 60 Tablet In 1 Bottle (67877-286-60),250,RC,67877-286-60,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ibuprofen: 100 Tablet, Film Coated In 1 Bottle (67877-319-01)",250,RC,67877-319-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metformin Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (67877-414-01)",250,RC,67877-414-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metformin Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (67877-414-01)",250,RC,67877-414-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 1 Blister Pack In 1 Carton (67877-419-33)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,67877-419-33,NDC,,,facility,both,1,EA,,5.03,5.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 1 Blister Pack In 1 Carton (67877-419-33)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,67877-419-33,NDC,,,facility,both,1,EA,,5.05,5.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefdinir: 60 Capsule In 1 Bottle (67877-543-60),250,RC,67877-543-60,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefdinir: 60 Capsule In 1 Bottle (67877-543-60),250,RC,67877-543-60,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 100 Tablet In 1 Bottle (67877-589-01),250,RC,67877-589-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 100 Tablet In 1 Bottle (67877-589-01),250,RC,67877-589-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-638-30)",250,RC,67877-638-30,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-639-30)",250,RC,67877-639-30,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-374-12,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 30 Tablet, Film Coated In 1 Bottle (65862-927-30)",250,RC,65862-927-30,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65862-930-08,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65862-930-08,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opsumit: 1 Blister Pack In 1 Carton (66215-501-15)  / 15 Tablet, Film Coated In 1 Blister Pack",250,RC,66215-501-15,NDC,,,facility,both,1,EA,,924.57,924.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66259-146-01,NDC,,,facility,both,1,EA,,171.17,171.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66302-616-01,NDC,,,facility,both,1,EA,,471.03,471.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66302-664-01,NDC,,,facility,both,1,EA,,471.03,471.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-001-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-001-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)",250,RC,65862-921-27,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-002-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-008-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-008-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66658-234-01,NDC,,,facility,both,1,EA,,408.16,408.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kineret: 7 Syringe, Glass In 1 Carton (66658-234-07)  / .67 Ml In 1 Syringe, Glass",250,RC,66658-234-07,NDC,,,facility,both,1,EA,,399.44,399.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66553-002-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)",250,RC,65862-921-27,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (65862-908-01),250,RC,65862-908-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)",250,RC,65862-603-30,NDC,,,facility,both,1,EA,,4.23,4.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 1 Blister Pack In 1 Carton (65862-641-69)  / 6 Tablet, Film Coated In 1 Blister Pack",250,RC,65862-641-69,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ritonavir: 30 Tablet, Film Coated In 1 Bottle (65862-687-30)",250,RC,65862-687-30,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Extended Phenytoin Sodium: 1000 Capsule In 1 Bottle (65862-692-99),250,RC,65862-692-99,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Ml In 1 Bottle (65862-707-01),250,RC,65862-707-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 150 Ml In 1 Bottle (65862-707-55),250,RC,65862-707-55,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atazanavir Sulfate: 60 Capsule In 1 Bottle (65862-711-60),250,RC,65862-711-60,NDC,,,facility,both,1,EA,,5.37,5.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valganciclovir Hydrochloride: 60 Tablet In 1 Bottle (65862-753-60),250,RC,65862-753-60,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 30 Capsule, Delayed Release In 1 Bottle (65862-784-30)",250,RC,65862-784-30,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 30 Capsule, Delayed Release In 1 Bottle (65862-784-30)",250,RC,65862-784-30,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (65862-830-30)",250,RC,65862-830-30,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (65862-830-30)",250,RC,65862-830-30,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 100 Tablet, Film Coated In 1 Bottle (65862-859-01)",250,RC,65862-859-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (65862-891-30)",250,RC,65862-891-30,NDC,,,facility,both,1,EA,,3.01,3.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (65862-891-30)",250,RC,65862-891-30,NDC,,,facility,both,1,EA,,3.01,3.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,65862-898-28,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66689-062-01,NDC,,,facility,both,1,EA,,16.66,16.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-182-00,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-196-00,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (67457-217-20)  / 20 Ml In 1 Vial, Multi-Dose",250,RC,67457-217-20,NDC,,,facility,both,1,EA,,33.06,33.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-228-00,NDC,,,facility,both,1,EA,,7.29,7.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-228-00,NDC,,,facility,both,1,EA,,7.33,7.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-228-00,NDC,,,facility,both,1,EA,,5.26,5.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (67457-228-05)  / 5 Ml In 1 Vial, Multi-Dose (67457-228-00)",250,RC,67457-228-05,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-251-00,NDC,,,facility,both,1,EA,,29.5,29.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Moxifloxacin Hydrochloride: 1 Bag In 1 Carton (67457-323-25)  / 250 Ml In 1 Bag,250,RC,67457-323-25,NDC,,,facility,both,1,EA,,19.02,19.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-340-00,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 10 Vial In 1 Carton (67457-340-01)  / 20 Ml In 1 Vial (67457-340-00),250,RC,67457-340-01,NDC,,,facility,both,1,EA,,14.95,14.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-374-12,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Modafinil: 30 Tablet In 1 Bottle (65862-601-30),250,RC,65862-601-30,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,67457-108-00,NDC,,,facility,both,1,EA,,17.67,17.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Northera: 90 Capsule In 1 Bottle (67386-820-19),250,RC,67386-820-19,NDC,,,facility,both,1,EA,,83.58,83.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 10 VIAL, SINGLE-DOSE in 1 CARTON (66794-210-41)  / 2 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE (66794-210-02) ",250,RC,66794-210-41,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,66794-219-63,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate Hfa: 1 Inhaler In 1 Carton (66993-078-96)  / 120 Aerosol, Metered In 1 Inhaler",250,RC,66993-078-96,NDC,,,facility,both,1,EA,,239.81,239.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate Hfa: 1 Inhaler In 1 Carton (66993-079-96)  / 120 Aerosol, Metered In 1 Inhaler",250,RC,66993-079-96,NDC,,,facility,both,1,EA,,319.32,319.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tafluprost Ophthalmic: 3 Pouch In 1 Carton (66993-429-30)  / 10 Vial, Single-Use In 1 Pouch (66993-429-81)  / .3 Ml In 1 Vial, Single-Use",250,RC,66993-429-30,NDC,,,facility,both,1,EA,,6.96,6.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-456-30)",250,RC,66993-456-30,NDC,,,facility,both,1,EA,,22.81,22.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-456-30)",250,RC,66993-456-30,NDC,,,facility,both,1,EA,,22.75,22.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)",250,RC,66993-457-30,NDC,,,facility,both,1,EA,,22.75,22.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)",250,RC,66993-457-30,NDC,,,facility,both,1,EA,,22.76,22.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Northera: 90 Capsule In 1 Bottle (67386-821-19),250,RC,67386-821-19,NDC,,,facility,both,1,EA,,159.2,159.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)",250,RC,69452-150-20,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01)  / 10 Ml In 1 Vial, Single-Dose",250,RC,72603-152-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (72603-220-01)",250,RC,72603-220-01,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-221-01,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 1 Bottle In 1 Carton (72603-240-01)  / 473 Ml In 1 Bottle,250,RC,72603-240-01,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-302-01,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-302-01,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-314-01,NDC,,,facility,both,1,EA,,7.82,7.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-314-01,NDC,,,facility,both,1,EA,,8,8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-139-01,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 100 Tablet In 1 Bottle (72603-134-01),250,RC,72603-134-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-416-01,NDC,,,facility,both,1,EA,,3.14,3.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-417-01,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-422-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-507-01,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-510-01,NDC,,,facility,both,1,EA,,5.41,5.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ofloxacin: 1 Bottle, Dropper In 1 Carton (72485-613-10)  / 5 Ml In 1 Bottle, Dropper",250,RC,72485-613-10,NDC,,,facility,both,1,EA,,18.39,18.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythromycin: 50 Tube In 1 Carton (72485-670-31)  / 1 G In 1 Tube,250,RC,72485-670-31,NDC,,,facility,both,1,EA,,8.53,8.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 100 Capsule In 1 Bottle (72578-002-01),250,RC,72578-002-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 100 Capsule In 1 Bottle (72578-002-01),250,RC,72578-002-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Febuxostat: 30 Tablet In 1 Bottle (72578-136-06),250,RC,72578-136-06,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 100 Tablet In 1 Bottle (72603-134-01),250,RC,72603-134-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-387-01,NDC,,,facility,both,1,EA,,2.92,2.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26),250,RC,72888-125-26,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26),250,RC,72888-125-26,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Package (72888-144-30)",250,RC,72888-144-30,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Tablet In 1 Bottle (72888-152-01),250,RC,72888-152-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Package (72888-175-30)",250,RC,72888-175-30,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Package (72888-175-30)",250,RC,72888-175-30,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 30 Tablet In 1 Bottle (72888-178-30),250,RC,72888-178-30,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (73043-010-03),250,RC,73043-010-03,NDC,,,facility,both,1,EA,,7.02,7.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73043-023-91,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73043-023-91,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73043-023-91,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass",250,RC,73070-100-11,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72888-125-15,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (72888-114-01),250,RC,72888-114-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72603-474-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72611-719-01,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72611-722-01,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nurtec Odt: 1 Blister Pack In 1 Carton (72618-3000-2)  / 8 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,72618-3000-2,NDC,,,facility,both,1,EA,,229.95,229.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nurtec Odt: 1 Blister Pack In 1 Carton (72618-3000-2)  / 8 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,72618-3000-2,NDC,,,facility,both,1,EA,,230.5,230.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tizanidine: 150 Tablet In 1 Bottle, Plastic (72789-325-77)",250,RC,72789-325-77,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tizanidine: 150 Tablet In 1 Bottle, Plastic (72789-325-77)",250,RC,72789-325-77,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72888-024-06,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72888-024-06,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-034-01)",250,RC,72888-034-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-034-01)",250,RC,72888-034-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Coated In 1 Bottle (72888-080-01)",250,RC,72888-080-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Coated In 1 Bottle (72888-080-01)",250,RC,72888-080-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-403-01,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xcopri Titration Pack: 1 Kit In 1 Carton (71699-201-28)  *  1 Tablet In 1 Blister Pack *  1 Tablet, Film Coated In 1 Blister Pack",250,RC,71699-201-28,NDC,,,facility,both,1,EA,,7.17,7.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72078-034-00,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72078-035-00,NDC,,,facility,both,1,EA,,76.93,76.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ultiva: 10 Vial, Glass In 1 Carton (72078-035-02)  / 5 Ml In 1 Vial, Glass (72078-035-00)",250,RC,72078-035-02,NDC,,,facility,both,1,EA,,81.93,81.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 90 Capsule In 1 Bottle (72205-011-90),250,RC,72205-011-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-100-30)",250,RC,71699-100-30,NDC,,,facility,both,1,EA,,73.11,73.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 90 Capsule In 1 Bottle (72205-011-90),250,RC,72205-011-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 90 Capsule In 1 Bottle (72205-012-90),250,RC,72205-012-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 90 Capsule In 1 Bottle (72205-012-90),250,RC,72205-012-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 60 Capsule In 1 Bottle (72205-039-60),250,RC,72205-039-60,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 60 Capsule In 1 Bottle (72205-039-60),250,RC,72205-039-60,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 60 Capsule In 1 Bottle (72205-040-60),250,RC,72205-040-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 60 Capsule In 1 Bottle (72205-041-60),250,RC,72205-041-60,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-044-11)  / 10 Capsule In 1 Blister Pack,250,RC,72205-044-11,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71656-072-05,NDC,,,facility,both,1,EA,,19.64,19.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71506-028-59,NDC,,,facility,both,1,EA,,990.08,990.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (71288-721-11)  / 10 Ml In 1 Vial, Single-Dose",250,RC,71288-721-11,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doptelet: 1 Blister Pack In 1 Carton (71369-020-10)  / 10 Tablet, Film Coated In 1 Blister Pack (71369-020-11)",250,RC,71369-020-10,NDC,,,facility,both,1,EA,,826.93,826.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doptelet: 1 Blister Pack In 1 Carton (71369-020-15)  / 15 Tablet, Film Coated In 1 Blister Pack (71369-020-16)",250,RC,71369-020-15,NDC,,,facility,both,1,EA,,821.21,821.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71390-011-00,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Onelax Saline Laxative: 296 Ml In 1 Bottle (71399-0051-1),250,RC,71399-0051-1,NDC,,,facility,both,1,EA,,5.7,5.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1027-1),250,RC,71399-1027-1,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1028-1),250,RC,71399-1028-1,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71449-131-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gleolan: 1 Vial, Single-Dose In 1 Carton (71469-231-01)  / 1 Powder, For Solution In 1 Vial, Single-Dose",250,RC,71469-231-01,NDC,,,facility,both,1,EA,,3717.18,3717.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Moxifloxacin Ophthalmic Solution: 1 Bottle In 1 Carton (72266-158-01)  / 3 Ml In 1 Bottle,250,RC,72266-158-01,NDC,,,facility,both,1,EA,,16.76,16.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Moxifloxacin Ophthalmic Solution: 1 Bottle In 1 Carton (72266-158-01)  / 3 Ml In 1 Bottle,250,RC,72266-158-01,NDC,,,facility,both,1,EA,,16.74,16.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-204-01,NDC,,,facility,both,1,EA,,3.83,3.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-234-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-237-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Maraviroc: 60 Tablet, Film Coated In 1 Bottle (72319-024-02)",250,RC,72319-024-02,NDC,,,facility,both,1,EA,,20.36,20.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Maraviroc: 60 Tablet, Film Coated In 1 Bottle (72319-025-02)",250,RC,72319-025-02,NDC,,,facility,both,1,EA,,20.26,20.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Caffeine Citrate: 1 Vial, Glass In 1 Carton (72485-104-01)  / 3 Ml In 1 Vial, Glass",250,RC,72485-104-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Nitroprusside: 1 Vial, Single-Dose In 1 Carton (72485-105-01)  / 2 Ml In 1 Vial, Single-Dose",250,RC,72485-105-01,NDC,,,facility,both,1,EA,,21.65,21.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-113-01,NDC,,,facility,both,1,EA,,122.79,122.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72485-116-01,NDC,,,facility,both,1,EA,,4.59,4.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicardipine Hydrochloride: 10 Vial In 1 Carton (72485-116-10)  / 10 Ml In 1 Vial (72485-116-01),250,RC,72485-116-10,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass",250,RC,73070-100-11,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-260-30),250,RC,72205-260-30,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-261-30),250,RC,72205-261-30,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-280-60)",250,RC,72205-280-60,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-280-60)",250,RC,72205-280-60,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (72241-023-05),250,RC,72241-023-05,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (72241-024-05),250,RC,72241-024-05,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (72241-024-05),250,RC,72241-024-05,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-102-01)  / 20 Ml In 1 Vial, Multi-Dose",250,RC,72266-102-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01)  / 20 Ml In 1 Vial, Single-Dose",250,RC,72266-131-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Carton (80830-2364-8)  / 50 Ml In 1 Vial (80830-2364-1),250,RC,80830-2364-8,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80830-2365-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81033-025-05,NDC,,,facility,both,1,EA,,10.33,10.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81033-104-05,NDC,,,facility,both,1,EA,,31.86,31.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81033-104-05,NDC,,,facility,both,1,EA,,32,32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atovaquone: 42 Cup, Unit-Dose In 1 Carton (81033-104-42)  / 5 Ml In 1 Cup, Unit-Dose (81033-104-05)",250,RC,81033-104-42,NDC,,,facility,both,1,EA,,34,34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81033-120-05,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81284-152-00,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81284-315-00,NDC,,,facility,both,1,EA,,614.49,614.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81284-411-00,NDC,,,facility,both,1,EA,,43.83,43.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81284-611-00,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81033-120-05,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80830-2362-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80830-2329-1,NDC,,,facility,both,1,EA,,11.57,11.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77683-06306,NDC,,,facility,both,1,EA,,77.91,77.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Celestone Soluspan: 1 Vial, Multi-Dose In 1 Box (78206-118-01)  / 5 Ml In 1 Vial, Multi-Dose",250,RC,78206-118-01,NDC,,,facility,both,1,EA,,10.6,10.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nexplanon: 1 Blister Pack In 1 Carton (78206-145-01)  / 1 Implant In 1 Blister Pack,250,RC,78206-145-01,NDC,,,facility,both,1,EA,,2266.31,2266.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nexplanon: 1 Blister Pack In 1 Carton (78206-145-01)  / 1 Implant In 1 Blister Pack,250,RC,78206-145-01,NDC,,,facility,both,1,EA,,2255.52,2255.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80196-291-14,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80196-291-14,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80830-1188-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80830-1691-1,NDC,,,facility,both,1,EA,,6.51,6.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,80830-1693-1,NDC,,,facility,both,1,EA,,17.28,17.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Phosphates: 5 Vial, Single-Dose In 1 Carton (80830-1693-3)  / 5 Ml In 1 Vial, Single-Dose (80830-1693-1)",250,RC,80830-1693-3,NDC,,,facility,both,1,EA,,17,17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81284-611-00,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-827-25,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81298-5010-1,NDC,,,facility,both,1,EA,,46.37,46.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81298-9655-1,NDC,,,facility,both,1,EA,,41.43,41.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-1201-42,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-2002-00,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-4089-46,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-4089-47,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-4089-48,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-4094-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-6162-68,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-6169-29,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-6175-91,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-6175-94,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-6175-95,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,99999-1014-65,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,99999-1014-65,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,99999-4707-16,NDC,,,facility,both,1,EA,,48.67,48.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,99999-4707-17,NDC,,,facility,both,1,EA,,49,49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,99999-1011-09,NDC,,,facility,both,1,EA,,16.99,16.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9999-1007-29,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isoniazid: 100 Tablet In 1 Bottle, Plastic (81665-108-10)",250,RC,81665-108-10,NDC,,,facility,both,1,EA,,4.7,4.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isoniazid: 30 Tablet In 1 Bottle, Plastic (81665-108-30)",250,RC,81665-108-30,NDC,,,facility,both,1,EA,,5.64,5.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81952-111-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine 5%: 30 Pouch In 1 Package (82347-0505-5)  / 14 G In 1 Pouch (82347-0505-4),250,RC,82347-0505-5,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine 5%: 30 Pouch In 1 Package (82347-0505-5)  / 14 G In 1 Pouch (82347-0505-4),250,RC,82347-0505-5,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose",250,RC,83090-011-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,83634-400-41,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,83634-401-41,NDC,,,facility,both,1,EA,,8.37,8.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,81298-9655-1,NDC,,,facility,both,1,EA,,41.65,41.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-827-25,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate 10 Gr. (650 Mg): 100 Blister Pack In 1 Box (77333-827-10)  / 1 Tablet In 1 Blister Pack (77333-827-25),250,RC,77333-827-10,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamoxifen Citrate: 60 Tablet, Film Coated In 1 Bottle (75907-058-60)",250,RC,75907-058-60,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamoxifen Citrate: 60 Tablet, Film Coated In 1 Bottle (75907-058-60)",250,RC,75907-058-60,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-004-01,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Iodide: 30 Ml In 1 Bottle, With Applicator (75834-280-30)",250,RC,75834-280-30,NDC,,,facility,both,1,EA,,4.66,4.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-009-96,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-204-00,NDC,,,facility,both,1,EA,,10.96,10.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide: 30 Pouch In 1 Carton (76204-100-01)  / 1 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule,250,RC,76204-100-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Erythromycin: 30 Tablet, Film Coated In 1 Bottle (75834-242-30)",250,RC,75834-242-30,NDC,,,facility,both,1,EA,,6.9,6.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nivagen Zinc Oxide: 28.4 G In 1 Tube (75834-170-01),250,RC,75834-170-01,NDC,,,facility,both,1,EA,,6.13,6.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nivagen Zinc Oxide: 28.4 G In 1 Tube (75834-170-01),250,RC,75834-170-01,NDC,,,facility,both,1,EA,,6.13,6.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-101-02,NDC,,,facility,both,1,EA,,9.58,9.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-102-01,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-116-02,NDC,,,facility,both,1,EA,,4.63,4.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-120-02,NDC,,,facility,both,1,EA,,11.9,11.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-146-33,NDC,,,facility,both,1,EA,,98,98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-156-02,NDC,,,facility,both,1,EA,,7.08,7.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73177-163-33,NDC,,,facility,both,1,EA,,97.58,97.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73293-0001-1,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Viokace: 1 Bottle In 1 Carton (73562-104-10)  / 100 Tablet In 1 Bottle,250,RC,73562-104-10,NDC,,,facility,both,1,EA,,7.99,7.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Viokace: 1 Bottle In 1 Carton (73562-104-10)  / 100 Tablet In 1 Bottle,250,RC,73562-104-10,NDC,,,facility,both,1,EA,,7.87,7.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-110-01)",250,RC,73562-110-01,NDC,,,facility,both,1,EA,,7.88,7.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-116-01)",250,RC,73562-116-01,NDC,,,facility,both,1,EA,,19.42,19.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Viokace: 1 Bottle In 1 Carton (73562-208-10)  / 100 Tablet In 1 Bottle,250,RC,73562-208-10,NDC,,,facility,both,1,EA,,15.85,15.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,250,RC,76204-200-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,250,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate: 1 Syringe In 1 Carton (76329-3352-1)  / 50 Ml In 1 Syringe,250,RC,76329-3352-1,NDC,,,facility,both,1,EA,,32.05,32.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate: 1 Syringe In 1 Carton (76329-3352-1)  / 50 Ml In 1 Syringe,250,RC,76329-3352-1,NDC,,,facility,both,1,EA,,30.57,30.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naloxone Hydrochloride: 10 Syringe In 1 Box (76329-3369-1)  / 2 Ml In 1 Syringe,250,RC,76329-3369-1,NDC,,,facility,both,1,EA,,17.97,17.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76329-8261-0,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 1 Vial In 1 Carton (76329-9060-0)  / 30 Ml In 1 Vial,250,RC,76329-9060-0,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nadolol: 100 Tablet In 1 Bottle (76385-133-01),250,RC,76385-133-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-031-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-031-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-049-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-049-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-812-25,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,77333-812-25,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,73070-103-10,NDC,,,facility,both,1,EA,,26.98,26.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,250,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 10 Carton In 1 Package (76329-3318-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,250,RC,76329-3318-1,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,250,RC,76204-600-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,250,RC,76204-600-01,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76204-700-11,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76204-700-11,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76204-800-11,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,76204-900-11,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nadolol: 100 Tablet In 1 Bottle (76282-347-01),250,RC,76282-347-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nadolol: 100 Tablet In 1 Bottle (76282-347-01),250,RC,76282-347-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Bottle In 1 Carton (76282-740-30)  / 30 Tablet In 1 Bottle,250,RC,76282-740-30,NDC,,,facility,both,1,EA,,12.94,12.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Bottle In 1 Carton (76282-740-30)  / 30 Tablet In 1 Bottle,250,RC,76282-740-30,NDC,,,facility,both,1,EA,,12.91,12.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Syringe In 1 Carton (76329-1240-1)  / .5 Ml In 1 Syringe,250,RC,76329-1240-1,NDC,,,facility,both,1,EA,,40.06,40.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose Monohydrate: 1 Syringe In 1 Carton (76329-3302-1)  / 50 Ml In 1 Syringe,250,RC,76329-3302-1,NDC,,,facility,both,1,EA,,25.43,25.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Chloride: 10 Syringe In 1 Package (76329-3304-1)  / 10 Ml In 1 Syringe,250,RC,76329-3304-1,NDC,,,facility,both,1,EA,,19.15,19.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)",250,RC,69452-150-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-716-11,NDC,,,facility,both,1,EA,,7.43,7.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (71288-700-06)  / 5 Ml In 1 Vial, Multi-Dose (71288-700-05)",250,RC,71288-700-06,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1611-44,NDC,,,facility,both,1,EA,,24.6,24.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1611-44,NDC,,,facility,both,1,EA,,24.56,24.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1622-03,NDC,,,facility,both,1,EA,,6.3,6.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-9053-05,NDC,,,facility,both,1,EA,,15.58,15.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-9120-43,NDC,,,facility,both,1,EA,,9.11,9.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1552-07,NDC,,,facility,both,1,EA,,12.98,12.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70095-025-01,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70100-424-01,NDC,,,facility,both,1,EA,,125.8,125.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Indocyanine Green: 6 Package In 1 Carton (70100-424-02)  / 1 Kit In 1 Package *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial *  10 Ml In 1 Vial, Plastic (0409-4887-17)",250,RC,70100-424-02,NDC,,,facility,both,1,EA,,86.05,86.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70121-1049-1,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70121-1453-1,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1475-50,NDC,,,facility,both,1,EA,,12.03,12.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1455-46,NDC,,,facility,both,1,EA,,22.78,22.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1005-38,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1030-36,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1046-46,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1046-46,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1068-07,NDC,,,facility,both,1,EA,,13.28,13.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1094-36,NDC,,,facility,both,1,EA,,30.37,30.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1094-36,NDC,,,facility,both,1,EA,,8.01,8.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1105-37,NDC,,,facility,both,1,EA,,23.57,23.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1120-43,NDC,,,facility,both,1,EA,,11.9,11.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1120-43,NDC,,,facility,both,1,EA,,10.29,10.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1135-44,NDC,,,facility,both,1,EA,,19.93,19.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1175-46,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1418-36,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70092-1433-50,NDC,,,facility,both,1,EA,,15.39,15.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70069-829-01)  / 230 Ml In 1 Bottle, Glass",250,RC,70069-829-01,NDC,,,facility,both,1,EA,,86.53,86.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (70505-100-10)",250,RC,70505-100-10,NDC,,,facility,both,1,EA,,5.34,5.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70512-842-01,NDC,,,facility,both,1,EA,,2.69,2.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Polymyxin B: 1 Vial, Glass In 1 Carton (70594-049-01)  / 1 Injection, Powder, For Solution In 1 Vial, Glass",250,RC,70594-049-01,NDC,,,facility,both,1,EA,,19.12,19.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate: 1 Tube In 1 Carton (70677-1000-1)  / 30 G In 1 Tube,250,RC,70677-1000-1,NDC,,,facility,both,1,EA,,3.88,3.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Droxidopa: 90 Capsule In 1 Bottle (70436-140-06),250,RC,70436-140-06,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine Hydrochloride: 1 Tube In 1 Carton (70677-1003-1)  / 30 G In 1 Tube,250,RC,70677-1003-1,NDC,,,facility,both,1,EA,,15.67,15.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allergy Relief: 1 Bottle, Plastic In 1 Carton (70677-1015-2)  / 100 Capsule In 1 Bottle, Plastic",250,RC,70677-1015-2,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Foster And Thrive Nasal: 1 Bottle, Spray In 1 Carton (70677-1037-1)  / 30 Ml In 1 Bottle, Spray",250,RC,70677-1037-1,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Foster And Thrive Nasal: 1 Bottle, Spray In 1 Carton (70677-1037-1)  / 30 Ml In 1 Bottle, Spray",250,RC,70677-1037-1,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Foster And Thrive Stomach Relief: 1 Bottle In 1 Carton (70677-1082-1)  / 40 Tablet In 1 Bottle,250,RC,70677-1082-1,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Foster And Thrive Stomach Relief: 1 Bottle In 1 Carton (70677-1082-1)  / 40 Tablet In 1 Bottle,250,RC,70677-1082-1,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Foster And Thrive Ready To Use Saline Laxative: 1 Bottle In 1 Carton (70677-1089-1)  / 133 Ml In 1 Bottle,250,RC,70677-1089-1,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1111-1)",250,RC,70677-1111-1,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetrabenazine: 112 Tablet In 1 Bottle (70436-102-09),250,RC,70436-102-09,NDC,,,facility,both,1,EA,,7.67,7.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70121-1720-1,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70127-100-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyoscyamine Sulfate: 100 TABLET in 1 BOTTLE (70156-105-01) ,250,RC,70156-105-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Famotidine: 50 Ml In 1 Bottle (70377-113-11),250,RC,70377-113-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70377-118-31)  / 230 Ml In 1 Bottle, Glass",250,RC,70377-118-31,NDC,,,facility,both,1,EA,,112.27,112.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70377-118-31)  / 230 Ml In 1 Bottle, Glass",250,RC,70377-118-31,NDC,,,facility,both,1,EA,,108.8,108.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Azithromycin: 10 Vial In 1 Box (70436-019-82)  / 5 Ml In 1 Vial,250,RC,70436-019-82,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 10 Vial In 1 Carton (70436-021-82)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,70436-021-82,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Bottle, Plastic (70436-036-04)",250,RC,70436-036-04,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valganciclovir Hydrochloride: 100 Ml In 1 Bottle (70069-810-01),250,RC,70069-810-01,NDC,,,facility,both,1,EA,,96.95,96.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Phosphate: 25 Bottle In 1 Carton (70069-747-25)  / 15 Ml In 1 Bottle,250,RC,70069-747-25,NDC,,,facility,both,1,EA,,6.48,6.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-747-01,NDC,,,facility,both,1,EA,,7.88,7.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Acetate: 50 Ml In 1 Vial, Pharmacy Bulk Package (69784-230-10)",250,RC,69784-230-10,NDC,,,facility,both,1,EA,,34.15,34.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nabi-Hb: 1 Vial, Single-Use In 1 Carton (69800-4203-1)  / 5 Ml In 1 Vial, Single-Use (69800-4203-2)",250,RC,69800-4203-1,NDC,,,facility,both,1,EA,,356.34,356.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nabi-Hb: 1 Vial, Single-Use In 1 Carton (69800-4203-1)  / 5 Ml In 1 Vial, Single-Use (69800-4203-2)",250,RC,69800-4203-1,NDC,,,facility,both,1,EA,,230.41,230.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nexobrid: 1 Kit In 1 Carton (69866-2005-3)  *  5 G In 1 Vial, Glass (69866-2003-1)  *  50 G In 1 Jar (69866-2004-2)",250,RC,69866-2005-3,NDC,,,facility,both,1,EA,,6165.44,6165.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Bottle In 1 Carton (69918-101-01)  / 100 Tablet In 1 Bottle,250,RC,69918-101-01,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Bottle In 1 Carton (69918-201-01)  / 100 Tablet In 1 Bottle,250,RC,69918-201-01,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30),250,RC,69918-301-30,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30),250,RC,69918-301-30,NDC,,,facility,both,1,EA,,3.6,3.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01),250,RC,69918-899-01,NDC,,,facility,both,1,EA,,8.47,8.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Senna: 100 Tablet In 1 Bottle (69618-064-01),250,RC,69618-064-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Senna: 100 Tablet In 1 Bottle (69618-064-01),250,RC,69618-064-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infants Gas Relief Drops: 1 Bottle, Dropper In 1 Carton (69618-059-51)  / 30 Ml In 1 Bottle, Dropper",250,RC,69618-059-51,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ergocalciferol: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-151-20)",250,RC,69452-151-20,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ergocalciferol: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-151-20)",250,RC,69452-151-20,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ethosuximide: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-152-20)",250,RC,69452-152-20,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69452-156-74,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Progesterone: 100 Capsule In 1 Bottle (69452-233-20),250,RC,69452-233-20,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69543-451-01,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,69543-451-01,NDC,,,facility,both,1,EA,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (69616-272-30),250,RC,69616-272-30,NDC,,,facility,both,1,EA,,37.42,37.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (69616-272-30),250,RC,69616-272-30,NDC,,,facility,both,1,EA,,37.42,37.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (69616-274-30),250,RC,69616-274-30,NDC,,,facility,both,1,EA,,73.92,73.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (69616-274-30),250,RC,69616-274-30,NDC,,,facility,both,1,EA,,71.83,71.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Carbonate 500 Mg: 150 Tablet, Chewable In 1 Bottle, Plastic (69618-020-15)",250,RC,69618-020-15,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Carbonate 500 Mg: 150 Tablet, Chewable In 1 Bottle, Plastic (69618-020-15)",250,RC,69618-020-15,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70004-923-59,NDC,,,facility,both,1,EA,,29.56,29.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-019-01,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-021-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01)  / 10 Ml In 1 Bottle,250,RC,70069-051-01,NDC,,,facility,both,1,EA,,27.73,27.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01)  / 10 Ml In 1 Bottle,250,RC,70069-051-01,NDC,,,facility,both,1,EA,,28.23,28.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ropivacaine Hydrochloride: 1 Vial In 1 Carton (70069-064-01)  / 30 Ml In 1 Vial,250,RC,70069-064-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-101-01,NDC,,,facility,both,1,EA,,4.72,4.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-101-01,NDC,,,facility,both,1,EA,,6.69,6.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tropicamide: 1 Bottle In 1 Carton (70069-121-01)  / 15 Ml In 1 Bottle,250,RC,70069-121-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tropicamide: 1 Bottle In 1 Carton (70069-121-01)  / 15 Ml In 1 Bottle,250,RC,70069-121-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (70069-191-01)  / 15 Ml In 1 Bottle,250,RC,70069-191-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01)  / 5 Ml In 1 Bottle,250,RC,70069-231-01,NDC,,,facility,both,1,EA,,8.26,8.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01)  / 5 Ml In 1 Bottle,250,RC,70069-231-01,NDC,,,facility,both,1,EA,,8.28,8.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-361-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70069-746-01,NDC,,,facility,both,1,EA,,21.81,21.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1112-1)",250,RC,70677-1112-1,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Tablet, Coated In 1 Bottle (70010-770-01)",250,RC,70010-770-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Tablet, Coated In 1 Bottle (70010-754-01)",250,RC,70010-754-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70004-924-44,NDC,,,facility,both,1,EA,,37.24,37.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70004-926-44,NDC,,,facility,both,1,EA,,32.1,32.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70004-928-44,NDC,,,facility,both,1,EA,,37.49,37.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-030-01)",250,RC,70010-030-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-030-01)",250,RC,70010-030-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (70010-113-01)",250,RC,70010-113-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (70010-113-01)",250,RC,70010-113-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",250,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",250,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Tablet In 1 Bottle (70010-162-01),250,RC,70010-162-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Tablet In 1 Bottle (70010-162-01),250,RC,70010-162-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)",250,RC,70010-491-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)",250,RC,70010-491-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Tablet, Coated In 1 Bottle (70010-754-01)",250,RC,70010-754-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1112-1)",250,RC,70677-1112-1,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70700-116-84,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose",250,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Regadenoson: 1 Syringe, Plastic In 1 Carton (71288-201-85)  / 5 Ml In 1 Syringe, Plastic",250,RC,71288-201-85,NDC,,,facility,both,1,EA,,4.35,4.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluoxetine Hydrochloride: 120 Ml In 1 Bottle, Plastic (70954-600-10)",250,RC,70954-600-10,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71019-014-07,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa And Levodopa: 30 Tablet In 1 Bottle, Plastic (71205-877-30)",250,RC,71205-877-30,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71266-5040-1,NDC,,,facility,both,1,EA,,44.1,44.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71266-5083-1,NDC,,,facility,both,1,EA,,11.25,11.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71266-5100-1,NDC,,,facility,both,1,EA,,10.13,10.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71266-5103-1,NDC,,,facility,both,1,EA,,10.33,10.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71285-0422-1,NDC,,,facility,both,1,EA,,85.26,85.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71285-6060-1,NDC,,,facility,both,1,EA,,42.14,42.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71285-6074-1,NDC,,,facility,both,1,EA,,8.98,8.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71286-6003-2,NDC,,,facility,both,1,EA,,13.43,13.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-009-21,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluoxetine Hydrochloride: 120 Ml In 1 Bottle, Plastic (70954-600-10)",250,RC,70954-600-10,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-203-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-433-82,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-433-82,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-434-84,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-435-86,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-435-86,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-436-88,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-437-91,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-505-02,NDC,,,facility,both,1,EA,,9.77,9.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-600-10,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-700-05,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-432-80,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-432-80,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-203-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-303-01,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-402-10,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-403-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,71288-411-80,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enoxaparin Sodium: 1 Vial, Multi-Dose In 1 Carton (71288-426-03)  / 3 Ml In 1 Vial, Multi-Dose",250,RC,71288-426-03,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10),250,RC,70954-496-10,NDC,,,facility,both,1,EA,,128.31,128.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10),250,RC,70954-496-10,NDC,,,facility,both,1,EA,,224.54,224.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fomepizole: 1 Vial In 1 Carton (70710-1478-1)  / 1.5 Ml In 1 Vial,250,RC,70710-1478-1,NDC,,,facility,both,1,EA,,9.15,9.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70710-1643-1,NDC,,,facility,both,1,EA,,2.77,2.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70710-1643-1,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Micafungin: 1 Vial In 1 Carton (70710-1725-1)  / 5 Ml In 1 Vial,250,RC,70710-1725-1,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Indomethacin: 5 Blister Pack In 1 Carton (70710-1852-7)  / 6 Suppository In 1 Blister Pack (70710-1852-6),250,RC,70710-1852-7,NDC,,,facility,both,1,EA,,330.72,330.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-129-06)",250,RC,70748-129-06,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-130-06)",250,RC,70748-130-06,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-130-06)",250,RC,70748-130-06,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (70748-258-07)",250,RC,70748-258-07,NDC,,,facility,both,1,EA,,10.85,10.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70710-1852-6,NDC,,,facility,both,1,EA,,331.47,331.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Droxidopa: 90 Capsule In 1 Bottle (70710-1389-9),250,RC,70710-1389-9,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fosfomycin Tromethamine: 1 Dose Pack In 1 Carton (70700-268-94)  / 1 Powder In 1 Dose Pack,250,RC,70700-268-94,NDC,,,facility,both,1,EA,,145.16,145.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fosfomycin Tromethamine: 1 Powder In 1 Packet (70700-268-99),250,RC,70700-268-99,NDC,,,facility,both,1,EA,,145.16,145.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Deferasirox: 30 Tablet In 1 Bottle, Plastic (70700-269-30)",250,RC,70700-269-30,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Bottle In 1 Carton (70710-1014-1)  / 100 Tablet In 1 Bottle,250,RC,70710-1014-1,NDC,,,facility,both,1,EA,,49.29,49.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Bottle In 1 Carton (70710-1014-1)  / 100 Tablet In 1 Bottle,250,RC,70710-1014-1,NDC,,,facility,both,1,EA,,50.5,50.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1159-3)",250,RC,70710-1159-3,NDC,,,facility,both,1,EA,,15.53,15.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1159-3)",250,RC,70710-1159-3,NDC,,,facility,both,1,EA,,15.46,15.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1159-9)",250,RC,70710-1159-9,NDC,,,facility,both,1,EA,,15.46,15.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1159-9)",250,RC,70710-1159-9,NDC,,,facility,both,1,EA,,15.46,15.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1160-3)",250,RC,70710-1160-3,NDC,,,facility,both,1,EA,,16.92,16.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1160-3)",250,RC,70710-1160-3,NDC,,,facility,both,1,EA,,16.92,16.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70710-1359-1,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 500 Ml In 1 Bottle, Plastic (70752-131-14)",250,RC,70752-131-14,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70860-301-41,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70860-701-41,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-019-10),250,RC,70954-019-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-019-10),250,RC,70954-019-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 90 Capsule In 1 Bottle (70954-019-50),250,RC,70954-019-50,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-020-10),250,RC,70954-020-10,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-021-10),250,RC,70954-021-10,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-021-10),250,RC,70954-021-10,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dapsone: 30 Tablet In 1 Bottle (70954-136-10),250,RC,70954-136-10,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dapsone: 30 Tablet In 1 Bottle (70954-136-10),250,RC,70954-136-10,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levocarnitine: 118 Ml In 1 Bottle (70954-140-10),250,RC,70954-140-10,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyridostigmine: 473 Ml In 1 Bottle (70954-148-10),250,RC,70954-148-10,NDC,,,facility,both,1,EA,,7.82,7.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clorazepate Dipotassium: 30 Tablet In 1 Bottle (70954-159-30),250,RC,70954-159-30,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle (70954-212-10),250,RC,70954-212-10,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbamazepine: 1 Bottle In 1 Carton (70954-240-10)  / 450 Ml In 1 Bottle,250,RC,70954-240-10,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paroxetine: 250 Ml In 1 Bottle (70954-319-10),250,RC,70954-319-10,NDC,,,facility,both,1,EA,,48.59,48.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyrazinamide: 60 Tablet In 1 Bottle (70954-484-10),250,RC,70954-484-10,NDC,,,facility,both,1,EA,,8.22,8.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70860-126-41,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70860-100-41,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (70756-404-11),250,RC,70756-404-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (70756-404-11),250,RC,70756-404-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70756-612-12,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (70756-629-25)  / 2 Ml In 1 Bottle, Dropper",250,RC,70756-629-25,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (70756-649-35)  / 15 Ml In 1 Bottle, Dropper",250,RC,70756-649-35,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (70756-649-35)  / 15 Ml In 1 Bottle, Dropper",250,RC,70756-649-35,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Bottle (70756-703-60)",250,RC,70756-703-60,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Bottle (70756-703-60)",250,RC,70756-703-60,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 100 Tablet In 1 Bottle (70756-721-11),250,RC,70756-721-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lansoprazole: 90 Capsule, Delayed Release In 1 Bottle (70756-807-90)",250,RC,70756-807-90,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lansoprazole: 90 Capsule, Delayed Release In 1 Bottle (70756-807-90)",250,RC,70756-807-90,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cocaine Hydrochloride: 1 Bottle, Glass In 1 Carton (70839-362-04)  / 4 Ml In 1 Bottle, Glass",250,RC,70839-362-04,NDC,,,facility,both,1,EA,,487.07,487.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,70842-120-01,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4277-16,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)",250,RC,64380-883-04,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,64380-881-00,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (60219-1266-1)  / 10 Capsule In 1 Blister Pack,250,RC,60219-1266-1,NDC,,,facility,both,1,EA,,15.66,15.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (60219-1522-1),250,RC,60219-1522-1,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (60219-1523-1),250,RC,60219-1523-1,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etravirine: 120 Tablet In 1 Bottle, Plastic (60219-1721-7)",250,RC,60219-1721-7,NDC,,,facility,both,1,EA,,11.74,11.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etravirine: 60 Tablet In 1 Bottle, Plastic (60219-1722-6)",250,RC,60219-1722-6,NDC,,,facility,both,1,EA,,24.45,24.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine: 1 Bottle, Dropper In 1 Carton (60219-1748-2)  / 2 Ml In 1 Bottle, Dropper",250,RC,60219-1748-2,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Coated In 1 Bottle (60219-2348-1)",250,RC,60219-2348-1,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Coated In 1 Bottle (60219-2348-1)",250,RC,60219-2348-1,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59923-615-01,NDC,,,facility,both,1,EA,,9.04,9.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 75 Ml In 1 Bottle, Plastic (60432-065-75)",250,RC,60432-065-75,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 100 Tablet, Film Coated In 1 Bottle (60505-0083-2)",250,RC,60505-0083-2,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 100 Tablet, Film Coated In 1 Bottle (60505-0084-2)",250,RC,60505-0084-2,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glipizide: 100 Tablet In 1 Bottle (60505-0141-0),250,RC,60505-0141-0,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glipizide: 100 Tablet In 1 Bottle (60505-0141-0),250,RC,60505-0141-0,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (60505-0157-1)",250,RC,60505-0157-1,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (60505-0157-1)",250,RC,60505-0157-1,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Thiosulfate: 50 Ml In 1 Vial, Single-Dose (60267-705-50)",250,RC,60267-705-50,NDC,,,facility,both,1,EA,,192.63,192.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Misoprostol: 60 Tablet In 1 Bottle (59762-5008-1),250,RC,59762-5008-1,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 100 Tablet In 1 Bottle (59762-0075-1),250,RC,59762-0075-1,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (59762-0117-1)",250,RC,59762-0117-1,NDC,,,facility,both,1,EA,,3.14,3.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"ATORVASTATIN CALCIUM: 500 TABLET, FILM COATED in 1 BOTTLE (59762-0158-2) ",250,RC,59762-0158-2,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"ATORVASTATIN CALCIUM: 500 TABLET, FILM COATED in 1 BOTTLE (59762-0158-2) ",250,RC,59762-0158-2,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (59762-0180-3)  / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK",250,RC,59762-0180-3,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (59762-0180-3)  / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK",250,RC,59762-0180-3,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Latanoprost: 1 Bottle, Dropper In 1 Carton (59762-0333-2)  / 2.5 Ml In 1 Bottle, Dropper",250,RC,59762-0333-2,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Latanoprost: 1 Bottle, Dropper In 1 Carton (59762-0333-2)  / 2.5 Ml In 1 Bottle, Dropper",250,RC,59762-0333-2,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rifabutin: 100 Capsule In 1 Bottle (59762-1350-1),250,RC,59762-1350-1,NDC,,,facility,both,1,EA,,25.06,25.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"100 BLISTER PACK in 1 CARTON (59762-1710-1)  / 1 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,59762-1710-1,NDC,,,facility,both,1,EA,,4.22,4.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (59762-1720-1)",250,RC,59762-1720-1,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
medroxyprogesterone acetate: 1 BOTTLE in 1 CARTON (59762-3742-2)  / 100 TABLET in 1 BOTTLE,250,RC,59762-3742-2,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfasalazine: 1 Bottle In 1 Carton (59762-5000-5)  / 100 Tablet In 1 Bottle,250,RC,59762-5000-5,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfasalazine: 1 Bottle In 1 Carton (59762-5000-5)  / 100 Tablet In 1 Bottle,250,RC,59762-5000-5,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Misoprostol: 120 Tablet In 1 Bottle (59762-5007-2),250,RC,59762-5007-2,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (60505-0158-1)",250,RC,60505-0158-1,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (60505-0158-1)",250,RC,60505-0158-1,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0164-1),250,RC,60505-0164-1,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3111-0)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3111-0,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3111-0)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3111-0,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3113-0,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3113-0,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3250-6)",250,RC,60505-3250-6,NDC,,,facility,both,1,EA,,11.78,11.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3251-6)",250,RC,60505-3251-6,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (60505-3110-3)",250,RC,60505-3110-3,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3276-0)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,60505-3276-0,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Selegiline Hydrochloride: 60 Tablet In 1 Bottle (60505-3438-3),250,RC,60505-3438-3,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Selegiline Hydrochloride: 60 Tablet In 1 Bottle (60505-3438-3),250,RC,60505-3438-3,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Guanfacine Extended-Release: 100 Tablet, Extended Release In 1 Bottle (60505-3927-1)",250,RC,60505-3927-1,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4642-3)",250,RC,60505-4642-3,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4643-3)",250,RC,60505-4643-3,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (60505-3110-3)",250,RC,60505-3110-3,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2671-9)",250,RC,60505-2671-9,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0165-1),250,RC,60505-0165-1,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paxil: 250 Ml In 1 Bottle (60505-0402-5),250,RC,60505-0402-5,NDC,,,facility,both,1,EA,,64.14,64.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olopatadine Hydrochloride: 1 BOTTLE, PLASTIC in 1 CARTON (60505-0575-1)  / 5 mL in 1 BOTTLE, PLASTIC",250,RC,60505-0575-1,NDC,,,facility,both,1,EA,,69.49,69.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desmopressin Acetate: 1 Bottle, Spray In 1 Carton (60505-0815-0)  / 50 Spray In 1 Bottle, Spray",250,RC,60505-0815-0,NDC,,,facility,both,1,EA,,177.95,177.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitonin Salmon: 1 Bottle, Glass In 1 Carton (60505-0823-6)  / 30 Spray, Metered In 1 Bottle, Glass",250,RC,60505-0823-6,NDC,,,facility,both,1,EA,,105.51,105.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitonin Salmon: 1 Bottle, Glass In 1 Carton (60505-0823-6)  / 30 Spray, Metered In 1 Bottle, Glass",250,RC,60505-0823-6,NDC,,,facility,both,1,EA,,105.51,105.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate: 1 Bottle, Spray In 1 Carton (60505-0829-1)  / 120 Spray, Metered In 1 Bottle, Spray",250,RC,60505-0829-1,NDC,,,facility,both,1,EA,,33.8,33.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (60505-1321-1),250,RC,60505-1321-1,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (60505-1321-1),250,RC,60505-1321-1,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2578-9)",250,RC,60505-2578-9,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2578-9)",250,RC,60505-2578-9,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2579-9)",250,RC,60505-2579-9,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2579-9)",250,RC,60505-2579-9,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle (60505-2656-1),250,RC,60505-2656-1,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle (60505-2656-1),250,RC,60505-2656-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2671-9)",250,RC,60505-2671-9,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 100 Tablet In 1 Bottle (59762-0074-1),250,RC,59762-0074-1,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 100 Tablet In 1 Bottle (59762-0074-1),250,RC,59762-0074-1,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyvanse: 100 Capsule In 1 Bottle (59417-103-10),250,RC,59417-103-10,NDC,,,facility,both,1,EA,,23.36,23.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyvanse: 100 Capsule In 1 Bottle (59417-103-10),250,RC,59417-103-10,NDC,,,facility,both,1,EA,,22.93,22.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59630-266-01,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyvanse: 100 Capsule In 1 Bottle (59417-101-10),250,RC,59417-101-10,NDC,,,facility,both,1,EA,,23.36,23.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Niacin: 90 Tablet, Extended Release In 1 Bottle (59651-018-90)",250,RC,59651-018-90,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Darunavir: 30 Tablet, Film Coated In 1 Bottle (59651-086-30)",250,RC,59651-086-30,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (59651-214-30)  / 200 Spray, Metered In 1 Bottle, Spray",250,RC,59651-214-30,NDC,,,facility,both,1,EA,,26.02,26.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (59651-214-30)  / 200 Spray, Metered In 1 Bottle, Spray",250,RC,59651-214-30,NDC,,,facility,both,1,EA,,25.87,25.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Roflumilast: 30 Tablet In 1 Bottle (59651-275-30),250,RC,59651-275-30,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamoxifen Citrate: 60 Tablet, Film Coated In 1 Bottle (59651-299-60)",250,RC,59651-299-60,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamoxifen Citrate: 60 Tablet, Film Coated In 1 Bottle (59651-299-60)",250,RC,59651-299-60,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobazam: 1 Bottle In 1 Carton (59651-401-12)  / 120 Ml In 1 Bottle,250,RC,59651-401-12,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (59651-026-55),250,RC,59651-026-55,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59385-024-01,NDC,,,facility,both,1,EA,,29.02,29.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59385-023-01,NDC,,,facility,both,1,EA,,21.37,21.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycontin: 2 Blister Pack In 1 Carton (59011-440-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,59011-440-20,NDC,,,facility,both,1,EA,,28.73,28.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gleolan: 1 Vial, Single-Dose In 1 Carton (59137-231-01)  / 1 Powder, For Solution In 1 Vial, Single-Dose",250,RC,59137-231-01,NDC,,,facility,both,1,EA,,4259.63,4259.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rexulti: 1 Bottle In 1 Carton (59148-035-13)  / 30 Tablet In 1 Bottle,250,RC,59148-035-13,NDC,,,facility,both,1,EA,,90.53,90.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rexulti: 1 Bottle In 1 Carton (59148-037-13)  / 30 Tablet In 1 Bottle,250,RC,59148-037-13,NDC,,,facility,both,1,EA,,88.12,88.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Qvar Redihaler: 1 Inhaler In 1 Carton (59310-302-40)  / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister",250,RC,59310-302-40,NDC,,,facility,both,1,EA,,394.1,394.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Qvar Redihaler: 1 Inhaler In 1 Carton (59310-304-80)  / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister",250,RC,59310-304-80,NDC,,,facility,both,1,EA,,530,530,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Qvar Redihaler: 1 Inhaler In 1 Carton (59310-304-80)  / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister",250,RC,59310-304-80,NDC,,,facility,both,1,EA,,525.94,525.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paragard T 380A: 1 Pouch In 1 Carton (59365-5128-1)  / 1 Intrauterine Device In 1 Pouch,250,RC,59365-5128-1,NDC,,,facility,both,1,EA,,2126.6,2126.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59365-6065-0,NDC,,,facility,both,1,EA,,28.31,28.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59385-021-01,NDC,,,facility,both,1,EA,,13.48,13.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,59385-022-01,NDC,,,facility,both,1,EA,,13.48,13.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobazam: 1 Bottle In 1 Carton (59651-401-12)  / 120 Ml In 1 Bottle,250,RC,59651-401-12,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 100 Tablet In 1 Bottle (59651-455-01),250,RC,59651-455-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 100 Tablet In 1 Bottle (59651-455-01),250,RC,59651-455-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 7 Blister Pack In 1 Carton (59746-020-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,59746-020-22,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-113-06),250,RC,59746-113-06,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-115-06),250,RC,59746-115-06,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-115-06),250,RC,59746-115-06,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-172-06),250,RC,59746-172-06,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-173-06),250,RC,59746-173-06,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-175-06),250,RC,59746-175-06,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-175-06),250,RC,59746-175-06,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (59746-211-06)",250,RC,59746-211-06,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Tablet, Film Coated In 1 Bottle (59746-216-01)",250,RC,59746-216-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylprednisolone: 25 Tablet In 1 Bottle (59762-0049-1),250,RC,59762-0049-1,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 7 Blister Pack In 1 Carton (59746-020-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,59746-020-22,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 3 Blister Pack In 1 Carton (59746-010-32)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,59746-010-32,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prezcobix: 30 Tablet, Film Coated In 1 Bottle (59676-575-30)",250,RC,59676-575-30,NDC,,,facility,both,1,EA,,148.34,148.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01),250,RC,59651-457-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01),250,RC,59651-457-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-484-01),250,RC,59651-484-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-485-01),250,RC,59651-485-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-489-01),250,RC,59651-489-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Exemestane: 30 Tablet, Film Coated In 1 Bottle (59651-516-30)",250,RC,59651-516-30,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Exemestane: 30 Tablet, Film Coated In 1 Bottle (59651-516-30)",250,RC,59651-516-30,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Tablet In 1 Bottle (59651-722-01),250,RC,59651-722-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Tablet In 1 Bottle (59651-723-01),250,RC,59651-723-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)",250,RC,59676-278-01,NDC,,,facility,both,1,EA,,89.37,89.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)",250,RC,59676-278-01,NDC,,,facility,both,1,EA,,89.25,89.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prezista: 30 Tablet, Film Coated In 1 Bottle, Plastic (59676-566-30)",250,RC,59676-566-30,NDC,,,facility,both,1,EA,,129.95,129.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Intelence: 120 Tablet In 1 Bottle, Plastic (59676-570-01)",250,RC,59676-570-01,NDC,,,facility,both,1,EA,,22.56,22.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 25 Vial, Single-Use In 1 Carton (60505-6130-5)  / 2 Ml In 1 Vial, Single-Use (60505-6130-0)",250,RC,60505-6130-5,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-387-11,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-390-11,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-390-11,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-395-79,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-406-40,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-406-40,NDC,,,facility,both,1,EA,,9.49,9.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-387-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-428-11,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-437-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-437-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-443-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-443-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-446-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-446-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-428-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-384-11,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-384-11,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-303-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-312-11,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-325-11,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-325-11,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-326-95,NDC,,,facility,both,1,EA,,8.84,8.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-326-95,NDC,,,facility,both,1,EA,,8.91,8.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-333-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-333-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-336-11,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-336-11,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-345-11,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-345-11,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-349-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-349-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-356-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-369-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-369-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-293-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-447-11,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-486-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-487-11,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-487-11,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-495-11,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-495-11,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-497-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-486-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-497-11,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-506-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-506-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-508-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-508-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-519-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-544-11,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-484-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-484-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-450-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-450-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-453-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-453-11,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (60687-454-01)  / 1 Tablet In 1 Blister Pack (60687-454-11),250,RC,60687-454-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-454-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-461-11,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-464-01)  / 1 Tablet In 1 Blister Pack (60687-464-11)",250,RC,60687-464-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-464-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-464-11,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-473-01)  / 1 Capsule In 1 Blister Pack (60687-473-11)",250,RC,60687-473-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-473-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-473-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-484-01)  / 1 Capsule In 1 Blister Pack (60687-484-11)",250,RC,60687-484-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-484-01)  / 1 Capsule In 1 Blister Pack (60687-484-11)",250,RC,60687-484-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-447-11,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-293-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-292-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclosporine: 60 Vial In 1 Tray (60505-6202-2)  / .4 Ml In 1 Vial,250,RC,60505-6202-2,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine: 1 Bottle, Dropper In 1 Carton (60505-6226-0)  / 2 Ml In 1 Bottle, Dropper",250,RC,60505-6226-0,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-7061-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-7061-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-7062-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-7062-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclosporine: 60 Vial In 1 Tray (60505-6202-2)  / .4 Ml In 1 Vial,250,RC,60505-6202-2,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-7063-0,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-100-11,NDC,,,facility,both,1,EA,,5.17,5.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-100-11,NDC,,,facility,both,1,EA,,6.51,6.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-105-11,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-112-11,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-112-11,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-113-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-113-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-7063-0,NDC,,,facility,both,1,EA,,3.57,3.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-6157-0,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-6142-0,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",250,RC,60505-6146-0,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",250,RC,60505-6147-0,NDC,,,facility,both,1,EA,,2.32,2.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (60505-6148-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use",250,RC,60505-6148-0,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-6149-0,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-121-95,NDC,,,facility,both,1,EA,,3.26,3.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-122-11,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-217-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-217-11,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-224-11,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-227-11,NDC,,,facility,both,1,EA,,12.64,12.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leucovorin Calcium: 20 Blister Pack In 1 Box, Unit-Dose (60687-227-94)  / 1 Tablet In 1 Blister Pack (60687-227-11)",250,RC,60687-227-94,NDC,,,facility,both,1,EA,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-228-11,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-228-11,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-230-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-231-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-231-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-234-11,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-234-11,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-256-11,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-256-11,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-275-62,NDC,,,facility,both,1,EA,,9.09,9.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-292-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-206-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60505-6130-0,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-206-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-134-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-145-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-152-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-155-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-155-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-161-11,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cephalexin: 100 Blister Pack In 1 Box, Unit-Dose (60687-163-01)  / 1 Capsule In 1 Blister Pack (60687-163-11)",250,RC,60687-163-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cephalexin: 100 Blister Pack In 1 Box, Unit-Dose (60687-163-01)  / 1 Capsule In 1 Blister Pack (60687-163-11)",250,RC,60687-163-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-163-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-163-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-178-11,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-179-11,NDC,,,facility,both,1,EA,,9.35,9.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-195-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-195-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride Extended-Release: 100 Blister Pack In 1 Box, Unit-Dose (60687-206-01)  / 1 Capsule, Coated, Extended Release In 1 Blister Pack (60687-206-11)",250,RC,60687-206-01,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-549-11,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,59011-410-20,NDC,,,facility,both,1,EA,,8.99,8.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc: 1 Tube In 1 Box (58980-011-10)  / 28.35 G In 1 Tube,250,RC,58980-011-10,NDC,,,facility,both,1,EA,,5.7,5.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-202-00,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-202-00,NDC,,,facility,both,1,EA,,2.65,2.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (55150-207-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,55150-207-20,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (55150-208-30)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,55150-208-30,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esmolol Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-194-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-194-10,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmedetomidine: 25 Vial In 1 Carton (55150-209-02)  / 2 Ml In 1 Vial,250,RC,55150-209-02,NDC,,,facility,both,1,EA,,3.5,3.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (55150-219-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-219-10,NDC,,,facility,both,1,EA,,9.11,9.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etomidate: 10 Vial, Single-Dose In 1 Carton (55150-221-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-221-10,NDC,,,facility,both,1,EA,,3.66,3.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etomidate: 10 Vial, Single-Dose In 1 Carton (55150-222-20)  / 20 Ml In 1 Vial, Single-Dose",250,RC,55150-222-20,NDC,,,facility,both,1,EA,,8.17,8.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmedetomidine: 25 Vial In 1 Carton (55150-209-02)  / 2 Ml In 1 Vial,250,RC,55150-209-02,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adenosine: 1 Vial, Single-Dose In 1 Carton (55150-193-01)  / 30 Ml In 1 Vial, Single-Dose",250,RC,55150-193-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-165-05)  / 5 Ml In 1 Vial, Single-Dose",250,RC,55150-165-05,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sildenafil: 1 Vial, Single-Dose In 1 Carton (55150-166-13)  / 12.5 Ml In 1 Vial, Single-Dose",250,RC,55150-166-13,NDC,,,facility,both,1,EA,,212.38,212.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-167-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-167-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01)  / .5 Ml In 1 Vial, Single-Dose",250,RC,55150-173-01,NDC,,,facility,both,1,EA,,6.93,6.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01)  / .5 Ml In 1 Vial, Single-Dose",250,RC,55150-173-01,NDC,,,facility,both,1,EA,,6.9,6.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 10 Vial, Single-Dose In 1 Carton (55150-174-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",250,RC,55150-174-10,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 10 Vial, Single-Dose In 1 Carton (55150-177-05)  / 5 Ml In 1 Vial, Single-Dose",250,RC,55150-177-05,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tranexamic Acid: 10 Vial, Single-Dose In 1 Carton (55150-188-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-188-10,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-223-10,NDC,,,facility,both,1,EA,,4.81,4.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose",250,RC,55150-163-30,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Polymyxin B: 10 Vial In 1 Carton (55150-234-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,55150-234-10,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prochlorperazine Edisylate: 1 Vial, Multi-Dose In 1 Carton (55150-360-01)  / 2 Ml In 1 Vial, Multi-Dose",250,RC,55150-360-01,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-438-01,NDC,,,facility,both,1,EA,,7.72,7.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-459-01,NDC,,,facility,both,1,EA,,36.71,36.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-322-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diclegis: 100 Tablet, Delayed Release In 1 Bottle (55494-100-10)",250,RC,55494-100-10,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-236-01,NDC,,,facility,both,1,EA,,41.64,41.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Linezolid: 10 Pouch In 1 Carton (55150-242-51)  / 1 Bag In 1 Pouch / 300 Ml In 1 Bag,250,RC,55150-242-51,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levetiracetam: 10 Pouch In 1 Carton (55150-247-47)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,250,RC,55150-247-47,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Carton (55150-251-10)  / 10 Ml In 1 Vial, Multi-Dose",250,RC,55150-251-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetylcysteine: 4 Vial, Single-Dose In 1 Carton (55150-259-30)  / 30 Ml In 1 Vial, Single-Dose",250,RC,55150-259-30,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-273-01,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-20)  / 1 Injection In 1 Vial, Single-Dose",250,RC,55150-282-20,NDC,,,facility,both,1,EA,,22.32,22.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55150-297-01,NDC,,,facility,both,1,EA,,25.99,25.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 1 Vial, Single-Dose In 1 Carton (55150-308-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",250,RC,55150-308-01,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 1 Vial, Single-Dose In 1 Carton (55150-308-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",250,RC,55150-308-01,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (55150-225-05)  / 5 Ml In 1 Vial, Multi-Dose",250,RC,55150-225-05,NDC,,,facility,both,1,EA,,2.77,2.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose",250,RC,55150-163-30,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose",250,RC,55150-163-30,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (55111-153-30)",250,RC,55111-153-30,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (55111-153-30)",250,RC,55111-153-30,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tizanidine: 150 Tablet In 1 Bottle (55111-179-15),250,RC,55111-179-15,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tizanidine: 150 Tablet In 1 Bottle (55111-179-15),250,RC,55111-179-15,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 500 Tablet, Film Coated In 1 Bottle (55111-196-05)",250,RC,55111-196-05,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 500 Tablet, Film Coated In 1 Bottle (55111-196-05)",250,RC,55111-196-05,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 90 Tablet, Film Coated In 1 Bottle (55111-196-90)",250,RC,55111-196-90,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-262-79)",250,RC,55111-262-79,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-262-79)",250,RC,55111-262-79,NDC,,,facility,both,1,EA,,3.09,3.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-263-79)",250,RC,55111-263-79,NDC,,,facility,both,1,EA,,4.6,4.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rivastigmine Tartrate: 60 Capsule In 1 Bottle (55111-352-60),250,RC,55111-352-60,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rivastigmine Tartrate: 60 Capsule In 1 Bottle (55111-352-60),250,RC,55111-352-60,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-466-01)",250,RC,55111-466-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-466-01)",250,RC,55111-466-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 90 Tablet, Film Coated In 1 Bottle (55111-196-90)",250,RC,55111-196-90,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamivudine: 240 Ml In 1 Bottle, Plastic (54838-566-70)",250,RC,54838-566-70,NDC,,,facility,both,1,EA,,6.8,6.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram Hydrobromide: 240 mL in 1 BOTTLE, PLASTIC (54838-540-70) ",250,RC,54838-540-70,NDC,,,facility,both,1,EA,,13.68,13.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxepin Hydrochloride: 120 Ml In 1 Bottle, Plastic (54838-512-40)",250,RC,54838-512-40,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 100 Tablet In 1 Bottle (53746-511-01),250,RC,53746-511-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bethanechol Chloride: 100 Tablet In 1 Bottle (53746-571-01),250,RC,53746-571-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bethanechol Chloride: 100 Tablet In 1 Bottle (53746-571-01),250,RC,53746-571-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Promethazine Hydrochloride: 100 Tablet In 1 Bottle (53746-745-01),250,RC,53746-745-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pentasa: 240 Capsule In 1 Bottle (54092-189-81),250,RC,54092-189-81,NDC,,,facility,both,1,EA,,5.49,5.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoledronic Acid: 1 Vial In 1 Carton (54288-100-01)  / 5 Ml In 1 Vial,250,RC,54288-100-01,NDC,,,facility,both,1,EA,,10.02,10.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 1 Vial In 1 Carton (54288-120-01)  / 10 Ml In 1 Vial,250,RC,54288-120-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle, Plastic (54838-502-80)",250,RC,54838-502-80,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle, Plastic (54838-502-80)",250,RC,54838-502-80,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-467-01)",250,RC,55111-467-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-467-01)",250,RC,55111-467-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-117-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,55150-117-20,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-119-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,55150-119-30,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,55150-120-30,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,55150-121-50,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxacillin: 10 Vial In 1 Box (55150-128-24)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,55150-128-24,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-154-10)  / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-154-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-155-20)  / 20 Ml In 1 Vial, Single-Dose",250,RC,55150-155-20,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 10 Ampule In 1 Carton (55150-159-74)  / 5 Ml In 1 Ampule,250,RC,55150-159-74,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 10 Ampule In 1 Carton (55150-159-74)  / 5 Ml In 1 Ampule,250,RC,55150-159-74,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose",250,RC,55150-162-05,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose",250,RC,55150-162-05,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-116-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,55150-116-20,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Box (55150-114-20)  / 1 Injection, Powder, For Solution In 1 Vial",250,RC,55150-114-20,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-468-01)",250,RC,55111-468-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-468-01)",250,RC,55111-468-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Extended Release In 1 Bottle (55111-533-01)",250,RC,55111-533-01,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Extended Release In 1 Bottle (55111-533-01)",250,RC,55111-533-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55111-671-06,NDC,,,facility,both,1,EA,,37.54,37.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-678-10)  / .5 Ml In 1 Syringe (55111-678-11),250,RC,55111-678-10,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass",250,RC,55111-685-07,NDC,,,facility,both,1,EA,,2.67,2.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Montelukast Sodium: 90 Tablet, Coated In 1 Bottle (55111-725-90)",250,RC,55111-725-90,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Montelukast Sodium: 90 Tablet, Coated In 1 Bottle (55111-725-90)",250,RC,55111-725-90,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (55111-734-90)",250,RC,55111-734-90,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (55111-734-90)",250,RC,55111-734-90,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,59011-410-20,NDC,,,facility,both,1,EA,,9.08,9.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dibucaine: 1 Tube In 1 Box (57896-131-01)  / 28 G In 1 Tube,250,RC,57896-131-01,NDC,,,facility,both,1,EA,,7.13,7.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Stool Softener: 100 Capsule, Liquid Filled In 1 Bottle (57896-401-01)",250,RC,57896-401-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Stool Softener: 100 Capsule, Liquid Filled In 1 Bottle (57896-401-01)",250,RC,57896-401-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,57896-490-01,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,57896-490-01,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Geri-Lanta Maximum Strength: 355 Ml In 1 Bottle (57896-619-12),250,RC,57896-619-12,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Geri-Lanta Antacid Antigas: 355 Ml In 1 Bottle (57896-629-12),250,RC,57896-629-12,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dibucaine: 1 Tube In 1 Box (57896-131-01)  / 28 G In 1 Tube,250,RC,57896-131-01,NDC,,,facility,both,1,EA,,7.1,7.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (57237-058-60)",250,RC,57237-058-60,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (57237-058-60)",250,RC,57237-058-60,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (57237-077-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,57237-077-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (57237-077-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,57237-077-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Modafinil: 30 Tablet In 1 Bottle (57237-155-30),250,RC,57237-155-30,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (57237-181-90),250,RC,57237-181-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (57237-181-90),250,RC,57237-181-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamivudine: 240 Ml In 1 Bottle (57237-274-24),250,RC,57237-274-24,NDC,,,facility,both,1,EA,,6.41,6.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycerin Children: 2 Blister Pack In 1 Carton (57237-326-21)  / 6 Suppository In 1 Blister Pack (57237-326-16),250,RC,57237-326-21,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycerin Children: 5 Blister Pack In 1 Carton (57237-326-52)  / 5 Suppository In 1 Blister Pack (57237-326-51),250,RC,57237-326-52,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tramadol Hydrochloride: 100 Tablet In 1 Bottle (57664-377-08),250,RC,57664-377-08,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tramadol Hydrochloride: 100 Tablet In 1 Bottle (57664-377-08),250,RC,57664-377-08,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (57664-378-88),250,RC,57664-378-88,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metformin Hydrochloride: 100 Tablet In 1 Bottle (57664-397-51),250,RC,57664-397-51,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metformin Hydrochloride: 100 Tablet In 1 Bottle (57664-397-51),250,RC,57664-397-51,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (57664-808-88)",250,RC,57664-808-88,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Galantamine: 60 Tablet, Film Coated In 1 Bottle (57237-050-60)",250,RC,57237-050-60,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Geri-Mox Antacid Antigas: 355 Ml In 1 Bottle (57896-639-12),250,RC,57896-639-12,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simethicone: 100 Tablet, Chewable In 1 Bottle (57896-791-01)",250,RC,57896-791-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40)  / 5 Ml In 1 Bottle, Plastic",250,RC,58602-006-40,NDC,,,facility,both,1,EA,,13.74,13.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40)  / 5 Ml In 1 Bottle, Plastic",250,RC,58602-006-40,NDC,,,facility,both,1,EA,,13.72,13.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (58602-604-07)  / 100 G In 1 Tube,250,RC,58602-604-07,NDC,,,facility,both,1,EA,,13.88,13.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (58602-604-07)  / 100 G In 1 Tube,250,RC,58602-604-07,NDC,,,facility,both,1,EA,,13.72,13.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 1 Blister Pack In 1 Carton (58602-702-83)  / 10 Tablet In 1 Blister Pack,250,RC,58602-702-83,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 1 Blister Pack In 1 Carton (58602-702-83)  / 10 Tablet In 1 Blister Pack,250,RC,58602-702-83,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
M-Dryl: 473 Ml In 1 Bottle (58657-528-16),250,RC,58657-528-16,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
M-Dryl: 473 Ml In 1 Bottle (58657-528-16),250,RC,58657-528-16,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Tablet, Coated In 1 Bottle (58657-675-01)",250,RC,58657-675-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Theratears: 6 Pouch In 1 Carton (58790-003-30)  / 5 Vial In 1 Pouch / .6 Ml In 1 Vial,250,RC,58790-003-30,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,58914-501-01,NDC,,,facility,both,1,EA,,69.99,69.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc: 1 Tube In 1 Box (58980-011-10)  / 28.35 G In 1 Tube,250,RC,58980-011-10,NDC,,,facility,both,1,EA,,5.71,5.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
M-Dryl: 473 Ml In 1 Bottle (58657-528-16),250,RC,58657-528-16,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,58160-976-02,NDC,,,facility,both,1,EA,,159.06,159.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adult Low Dose Enteric Coated Aspirin: 1000 Tablet, Coated In 1 Bottle (57896-981-10)",250,RC,57896-981-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adult Low Dose Enteric Coated Aspirin: 1000 Tablet, Coated In 1 Bottle (57896-981-10)",250,RC,57896-981-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adult Low Dose Enteric Coated Aspirin: 120 Tablet, Coated In 1 Bottle (57896-981-12)",250,RC,57896-981-12,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adult Low Dose Enteric Coated Aspirin: 120 Tablet, Coated In 1 Bottle (57896-981-12)",250,RC,57896-981-12,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,58160-820-43,NDC,,,facility,both,1,EA,,38.3,38.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,58160-827-03,NDC,,,facility,both,1,EA,,218.93,218.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,58160-842-01,NDC,,,facility,both,1,EA,,64.8,64.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,58160-842-43,NDC,,,facility,both,1,EA,,73.42,73.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Boostrix: 10 Syringe In 1 Carton (58160-842-52)  / .5 Ml In 1 Syringe (58160-842-43),250,RC,58160-842-52,NDC,,,facility,both,1,EA,,73.33,73.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Menveo: 1 Kit In 1 Carton (58160-955-09)  *  .5 Ml In 1 Vial, Single-Dose (58160-958-01)  *  .5 Ml In 1 Vial, Single-Dose (58160-959-01)",250,RC,58160-955-09,NDC,,,facility,both,1,EA,,220.36,220.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simethicone: 100 Tablet, Chewable In 1 Bottle (57896-791-01)",250,RC,57896-791-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Galantamine: 60 Tablet, Film Coated In 1 Bottle (57237-049-60)",250,RC,57237-049-60,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensipar: 30 Tablet, Coated In 1 Bottle, Plastic (55513-073-30)",250,RC,55513-073-30,NDC,,,facility,both,1,EA,,31.59,31.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensipar: 30 Tablet, Coated In 1 Bottle, Plastic (55513-073-30)",250,RC,55513-073-30,NDC,,,facility,both,1,EA,,31.59,31.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55513-126-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55513-144-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55513-144-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-800-60)",250,RC,55513-800-60,NDC,,,facility,both,1,EA,,18.67,18.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-810-60)",250,RC,55513-810-60,NDC,,,facility,both,1,EA,,18.36,18.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55566-2800-0,NDC,,,facility,both,1,EA,,986.46,986.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cervidil: 1 Pouch In 1 Carton (55566-2800-1)  / 10 Mg In 1 Pouch (55566-2800-0),250,RC,55566-2800-1,NDC,,,facility,both,1,EA,,988.38,988.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55566-6500-1,NDC,,,facility,both,1,EA,,26.14,26.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,55513-267-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)",250,RC,64380-883-04,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-549-11,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-550-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-472-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensorcaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-472-17)  / 10 Ml In 1 Vial, Single-Dose (63323-472-03)",250,RC,63323-472-17,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-474-00,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-482-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-482-01,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-482-03,NDC,,,facility,both,1,EA,,8.27,8.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-482-03,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-482-05,NDC,,,facility,both,1,EA,,13.25,13.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-483-03,NDC,,,facility,both,1,EA,,2.83,2.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-483-27)  / 20 Ml In 1 Vial, Multi-Dose (63323-483-03)",250,RC,63323-483-27,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-57)  / 50 Ml In 1 Vial, Multi-Dose (63323-486-05)",250,RC,63323-486-57,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-481-01,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-468-02,NDC,,,facility,both,1,EA,,18.34,18.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-401-01,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-402-01,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-412-18,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cisatracurium: 10 Vial In 1 Carton (63323-417-10)  / 10 Ml In 1 Vial (63323-417-01),250,RC,63323-417-10,NDC,,,facility,both,1,EA,,4.94,4.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-421-01,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-434-41,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-452-00,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-452-00,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-461-01,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-462-01,NDC,,,facility,both,1,EA,,10.42,10.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-462-01,NDC,,,facility,both,1,EA,,12.33,12.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensorcaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-462-17)  / 10 Ml In 1 Vial, Single-Dose (63323-462-04)",250,RC,63323-462-17,NDC,,,facility,both,1,EA,,8.88,8.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-487-07,NDC,,,facility,both,1,EA,,5.26,5.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-487-37)  / 30 Ml In 1 Vial, Single-Dose (63323-487-07)",250,RC,63323-487-37,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-535-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-540-03,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-540-05,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-530-21,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-559-21,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-564-21,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-564-21,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-566-21,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-579-01,NDC,,,facility,both,1,EA,,32.5,32.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-523-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-488-07,NDC,,,facility,both,1,EA,,25.49,25.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-488-17)  / 10 Ml In 1 Vial, Single-Dose (63323-488-01)",250,RC,63323-488-17,NDC,,,facility,both,1,EA,,12.02,12.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-489-02,NDC,,,facility,both,1,EA,,23.72,23.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-489-17)  / 10 Ml In 1 Vial, Single-Dose (63323-489-01)",250,RC,63323-489-17,NDC,,,facility,both,1,EA,,12,12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-492-07,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-492-09,NDC,,,facility,both,1,EA,,5.6,5.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-57)  / 5 Ml In 1 Vial, Single-Dose (63323-492-09)",250,RC,63323-492-57,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-494-01,NDC,,,facility,both,1,EA,,12.11,12.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-494-01,NDC,,,facility,both,1,EA,,8.7,8.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproate Sodium: 10 Vial, Single-Dose In 1 Tray (63323-494-05)  / 5 Ml In 1 Vial, Single-Dose (63323-494-01)",250,RC,63323-494-05,NDC,,,facility,both,1,EA,,5.87,5.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-495-04,NDC,,,facility,both,1,EA,,3.44,3.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-495-04,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-495-27)  / 2 Ml In 1 Vial, Single-Dose (63323-495-09)",250,RC,63323-495-27,NDC,,,facility,both,1,EA,,4.2,4.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-507-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-508-01,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meropenem: 10 Vial In 1 Carton (63323-508-30)  / 20 Ml In 1 Vial (63323-508-01),250,RC,63323-508-30,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-517-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-487-17)  / 10 Ml In 1 Vial, Single-Dose (63323-487-01)",250,RC,63323-487-17,NDC,,,facility,both,1,EA,,16.61,16.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colistimethate: 1 Vial In 1 Box (63323-393-06)  / 2 Ml In 1 Vial,250,RC,63323-393-06,NDC,,,facility,both,1,EA,,19.84,19.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-95)  / 25 Ml In 1 Vial, Single-Dose",250,RC,63323-229-95,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-262-03,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-10)  / 10 Ml In 1 Vial (63323-269-01),250,RC,63323-269-10,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-269-22,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-30)  / 25 Ml In 1 Vial, Single-Dose",250,RC,63323-229-30,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-29)  / 20 Ml In 1 Vial (63323-269-22),250,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-269-35,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 20 Vial In 1 Box (63323-269-50)  / 50 Ml In 1 Vial (63323-269-30),250,RC,63323-269-50,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 20 Vial In 1 Box (63323-269-50)  / 50 Ml In 1 Vial (63323-269-30),250,RC,63323-269-50,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-180-00,NDC,,,facility,both,1,EA,,14.66,14.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyridoxine Hydrochloride: 25 Vial In 1 Tray (63323-180-01)  / 1 Ml In 1 Vial (63323-180-00),250,RC,63323-180-01,NDC,,,facility,both,1,EA,,19.1,19.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose",250,RC,63323-184-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-185-07,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-185-08,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-185-09,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-186-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-186-01,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-187-30)  / 30 Ml In 1 Vial, Single-Dose",250,RC,63323-187-30,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-201-03,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 25 Vial In 1 Tray (63323-201-10)  / 10 Ml In 1 Vial (63323-201-03),250,RC,63323-201-10,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-208-01,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-208-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine: 25 Vial, Single-Dose In 1 Tray (63323-208-05)  / 5 Ml In 1 Vial, Single-Dose (63323-208-01)",250,RC,63323-208-05,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine: 25 Vial, Single-Dose In 1 Tray (63323-208-05)  / 5 Ml In 1 Vial, Single-Dose (63323-208-01)",250,RC,63323-208-05,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-65)  / 100 Ml In 1 Vial (63323-269-35),250,RC,63323-269-65,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01),250,RC,63323-280-02,NDC,,,facility,both,1,EA,,3.3,3.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-322-01,NDC,,,facility,both,1,EA,,9.65,9.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-325-03,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-325-09,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-20)  / 20 Ml In 1 Vial, Single-Dose (63323-325-09)",250,RC,63323-325-20,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-360-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-360-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefotetan: 10 Vial In 1 Carton (63323-385-10)  / 10 Ml In 1 Vial (63323-385-01),250,RC,63323-385-10,NDC,,,facility,both,1,EA,,42.2,42.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-386-01,NDC,,,facility,both,1,EA,,36.28,36.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tobramycin: 25 Vial, Multi-Dose In 1 Tray (63323-306-02)  / 2 Ml In 1 Vial, Multi-Dose (63323-306-01)",250,RC,63323-306-02,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-584-21,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tobramycin: 6 Vial, Pharmacy Bulk Package In 1 Tray (63323-303-51)  / 30 Ml In 1 Vial, Pharmacy Bulk Package (63323-303-01)",250,RC,63323-303-51,NDC,,,facility,both,1,EA,,6.46,6.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-285-23)  / 20 Ml In 1 Vial, Single-Dose (63323-285-07)",250,RC,63323-285-23,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-286-35)  / 30 Ml In 1 Vial, Single-Dose (63323-286-11)",250,RC,63323-286-35,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-287-21)  / 20 Ml In 1 Vial, Single-Dose (63323-287-03)",250,RC,63323-287-21,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-288-03,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-288-07,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10)  / 10 Capsule In 1 Blister Pack",250,RC,63739-567-10,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10)  / 10 Capsule In 1 Blister Pack",250,RC,63739-567-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-686-10)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-686-10,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"meloxicam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-701-10)  / 10 TABLET in 1 BLISTER PACK",250,RC,63739-701-10,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-760-01,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-544-10,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-760-01,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyethylene Glycol 3350: 100 Packet In 1 Carton (63739-760-04)  / 17 G In 1 Packet (63739-760-01),250,RC,63739-760-04,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10)  / 10 Capsule In 1 Blister Pack,250,RC,63739-902-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10)  / 10 Capsule In 1 Blister Pack,250,RC,63739-902-10,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10)  / 10 Capsule In 1 Blister Pack,250,RC,63739-903-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10)  / 10 Capsule In 1 Blister Pack,250,RC,63739-903-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10)  / 10 Capsule In 1 Blister Pack,250,RC,63739-904-10,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10)  / 10 Capsule In 1 Blister Pack,250,RC,63739-904-10,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-544-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aspirin Chewable: 30 Blister Pack In 1 Box (63739-434-02)  / 10 Tablet In 1 Blister Pack,250,RC,63739-434-02,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 5 Ml In 1 Cup, Unit-Dose (63739-160-70)",250,RC,63739-160-70,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 5 Ml In 1 Cup, Unit-Dose (63739-160-70)",250,RC,63739-160-70,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 5 Blister Pack In 1 Carton (63739-178-30)  / 6 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-178-30,NDC,,,facility,both,1,EA,,20.85,20.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 10 Blister Pack In 1 Box (63739-192-10)  / 10 Tablet In 1 Blister Pack,250,RC,63739-192-10,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-193-72,NDC,,,facility,both,1,EA,,11.86,11.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-193-72,NDC,,,facility,both,1,EA,,12.1,12.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02)  / 10 Tablet, Coated In 1 Blister Pack",250,RC,63739-212-02,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02)  / 10 Tablet, Coated In 1 Blister Pack",250,RC,63739-212-02,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gas Relief: 30 Blister Pack In 1 Box (63739-225-02)  / 10 Tablet, Chewable In 1 Blister Pack",250,RC,63739-225-02,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gas Relief: 30 Blister Pack In 1 Box (63739-225-02)  / 10 Tablet, Chewable In 1 Blister Pack",250,RC,63739-225-02,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-236-10)  / 10 CAPSULE in 1 BLISTER PACK",250,RC,63739-236-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-236-10)  / 10 CAPSULE in 1 BLISTER PACK",250,RC,63739-236-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-327-10)  / 10 Tablet In 1 Blister Pack,250,RC,63739-327-10,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allopurinol: 10 Blister Pack In 1 Box, Unit-Dose (63739-410-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-410-10,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allopurinol: 10 Blister Pack In 1 Box, Unit-Dose (63739-410-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-410-10,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aspirin Chewable: 30 Blister Pack In 1 Box (63739-434-02)  / 10 Tablet In 1 Blister Pack,250,RC,63739-434-02,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-159-77,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,64253-900-30,NDC,,,facility,both,1,EA,,13.51,13.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Sulfate, Potassium Sulfate And Magnesium Sulfate Oral: 2 Bottle In 1 Carton (64380-116-01)  / 177 Ml In 1 Bottle (64380-116-02)",250,RC,64380-116-01,NDC,,,facility,both,1,EA,,118.05,118.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Capsule In 1 Container (64380-721-06),250,RC,64380-721-06,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)",250,RC,64380-737-06,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)",250,RC,64380-737-06,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (64380-741-06),250,RC,64380-741-06,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Polyethylene Glycol 3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride With Lemon Flavor: 4 L In 1 Jug (64380-769-21)",250,RC,64380-769-21,NDC,,,facility,both,1,EA,,50.51,50.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-797-01),250,RC,64380-797-01,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-799-01),250,RC,64380-799-01,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 100 Tablet In 1 Bottle (64380-833-06),250,RC,64380-833-06,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 100 Tablet In 1 Bottle (64380-834-06),250,RC,64380-834-06,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (64380-741-06),250,RC,64380-741-06,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-963-10)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-963-10,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-963-10)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-963-10,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-976-01,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-976-01,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10)  / 10 CAPSULE in 1 BLISTER PACK",250,RC,63739-984-10,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10)  / 10 CAPSULE in 1 BLISTER PACK",250,RC,63739-984-10,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 10 Blister Pack In 1 Box, Unit-Dose (63739-991-10)  / 10 Tablet, Coated In 1 Blister Pack",250,RC,63739-991-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 10 Blister Pack In 1 Box, Unit-Dose (63739-991-10)  / 10 Tablet, Coated In 1 Blister Pack",250,RC,63739-991-10,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-953-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-159-77,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-158-70,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-664-00,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-664-41,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-665-00,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetylcysteine: 3 Vial In 1 Carton (63323-690-30)  / 30 Ml In 1 Vial (63323-690-22),250,RC,63323-690-30,NDC,,,facility,both,1,EA,,41.55,41.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide: 1 Vial In 1 Box (63323-658-20)  / 18 Ml In 1 Vial,250,RC,63323-658-20,NDC,,,facility,both,1,EA,,49.05,49.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetylcysteine: 25 Vial In 1 Carton (63323-694-04)  / 4 Ml In 1 Vial (63323-694-22),250,RC,63323-694-04,NDC,,,facility,both,1,EA,,21.66,21.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-713-03,NDC,,,facility,both,1,EA,,5.47,5.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-724-01,NDC,,,facility,both,1,EA,,232.44,232.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12)  / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",250,RC,63323-739-12,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-751-00,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-586-21,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-589-21,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glucagon: 1 Kit In 1 Carton (63323-593-03)  *  1 Ml In 1 Vial, Single-Dose (63323-596-03)  *  1 Ml In 1 Vial, Single-Dose (63323-185-03)",250,RC,63323-593-03,NDC,,,facility,both,1,EA,,134.67,134.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-596-03,NDC,,,facility,both,1,EA,,194.8,194.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-604-00,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-614-00,NDC,,,facility,both,1,EA,,3.48,3.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-624-06,NDC,,,facility,both,1,EA,,3.73,3.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-624-07,NDC,,,facility,both,1,EA,,5.13,5.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 1 Vial, Single-Dose In 1 Carton (63323-806-50)  / 50 Ml In 1 Vial, Single-Dose",250,RC,63323-806-50,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-812-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aptiom: 30 Tablet In 1 Bottle (63402-208-30),250,RC,63402-208-30,NDC,,,facility,both,1,EA,,80.95,80.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Latuda: 30 Tablet, Film Coated In 1 Bottle (63402-302-30)",250,RC,63402-302-30,NDC,,,facility,both,1,EA,,72.65,72.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (63629-9179-1),250,RC,63629-9179-1,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ketoconazole: 120 Ml In 1 Bottle, Plastic (63646-010-04)",250,RC,63646-010-04,NDC,,,facility,both,1,EA,,18.82,18.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-005-32)  / 10 Capsule In 1 Blister Pack",250,RC,63739-005-32,NDC,,,facility,both,1,EA,,3.97,3.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-047-10)  / 10 TABLET in 1 BLISTER PACK",250,RC,63739-047-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-047-10)  / 10 TABLET in 1 BLISTER PACK",250,RC,63739-047-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-048-10)  / 10 TABLET in 1 BLISTER PACK",250,RC,63739-048-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midodrine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-145-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-145-10,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midodrine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-145-10)  / 10 Tablet In 1 Blister Pack",250,RC,63739-145-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63739-158-70,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 10 Blister Pack In 1 Carton (63323-584-99)  / 1 Syringe In 1 Blister Pack (63323-584-21)  / .8 Ml In 1 Syringe,250,RC,63323-584-99,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63361-243-88,NDC,,,facility,both,1,EA,,261.98,261.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-820-01,NDC,,,facility,both,1,EA,,4.72,4.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-820-04,NDC,,,facility,both,1,EA,,2.24,2.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-850-74,NDC,,,facility,both,1,EA,,14.61,14.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)",250,RC,63323-851-50,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)",250,RC,63323-851-50,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-881-01,NDC,,,facility,both,1,EA,,17.19,17.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-884-01,NDC,,,facility,both,1,EA,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (63323-884-06)  / 5 Ml In 1 Vial, Single-Dose (63323-884-01)",250,RC,63323-884-06,NDC,,,facility,both,1,EA,,12.6,12.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 1 Vial, Single-Dose In 1 Carton (63323-885-10)  / 5 Ml In 1 Vial, Single-Dose",250,RC,63323-885-10,NDC,,,facility,both,1,EA,,81.6,81.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-886-01,NDC,,,facility,both,1,EA,,10.49,10.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-930-00,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-965-02,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-868-11,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorometholone: 1 Bottle, Dropper In 1 Carton (60758-880-05)  / 5 Ml In 1 Bottle, Dropper",250,RC,60758-880-05,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cytomel: 100 Tablet In 1 Bottle (60793-116-01),250,RC,60793-116-01,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60793-701-02,NDC,,,facility,both,1,EA,,45.93,45.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-854-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate: 1 Tube In 1 Carton (61269-735-56)  / 28 G In 1 Tube,250,RC,61269-735-56,NDC,,,facility,both,1,EA,,3.46,3.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole 7: 7 Suppository In 1 Box (61269-736-07),250,RC,61269-736-07,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Docosanol: 1 Tube In 1 Package (61269-981-35)  / 2 G In 1 Tube,250,RC,61269-981-35,NDC,,,facility,both,1,EA,,26.19,26.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Docosanol: 1 Tube In 1 Package (61269-981-35)  / 2 G In 1 Tube,250,RC,61269-981-35,NDC,,,facility,both,1,EA,,20.01,20.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Proparacaine Hydrochloride: 1 Bottle In 1 Carton (61314-016-01)  / 15 Ml In 1 Bottle,250,RC,61314-016-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 1 Bottle In 1 Carton (61314-126-05)  / 5 Ml In 1 Bottle,250,RC,61314-126-05,NDC,,,facility,both,1,EA,,21.07,21.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 1 Bottle In 1 Carton (61314-126-05)  / 5 Ml In 1 Bottle,250,RC,61314-126-05,NDC,,,facility,both,1,EA,,21.07,21.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (61314-203-15)  / 15 Ml In 1 Bottle,250,RC,61314-203-15,NDC,,,facility,both,1,EA,,113.42,113.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (61314-204-15)  / 15 Ml In 1 Bottle,250,RC,61314-204-15,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-836-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-725-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-725-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-730-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-742-11,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-746-11,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-755-40,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-756-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-760-40,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-775-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-775-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-810-11,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-833-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-836-11,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-226-05)",250,RC,61314-226-05,NDC,,,facility,both,1,EA,,4.53,4.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-226-05)",250,RC,61314-226-05,NDC,,,facility,both,1,EA,,4.53,4.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-227-05)",250,RC,61314-227-05,NDC,,,facility,both,1,EA,,8.75,8.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silvadene: 50 G In 1 Jar (61570-131-50),250,RC,61570-131-50,NDC,,,facility,both,1,EA,,15.98,15.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61874-115-11,NDC,,,facility,both,1,EA,,87.11,87.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61874-115-11,NDC,,,facility,both,1,EA,,89.58,89.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Emtriva: 30 Capsule In 1 Bottle, Plastic (61958-0601-1)",250,RC,61958-0601-1,NDC,,,facility,both,1,EA,,32.33,32.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tybost: 30 Tablet, Film Coated In 1 Bottle (61958-1401-1)",250,RC,61958-1401-1,NDC,,,facility,both,1,EA,,18.06,18.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Genvoya: 30 Tablet In 1 Bottle, Plastic (61958-1901-1)",250,RC,61958-1901-1,NDC,,,facility,both,1,EA,,252.69,252.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silvadene: 400 G In 1 Jar (61570-131-40),250,RC,61570-131-40,NDC,,,facility,both,1,EA,,64.99,64.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Betaxolol Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-245-01)  / 5 Ml In 1 Bottle, Plastic",250,RC,61314-245-01,NDC,,,facility,both,1,EA,,92.14,92.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61314-318-05,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61314-326-05,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tropicamide: 1 Bottle, Plastic In 1 Carton (61314-355-02)  / 15 Ml In 1 Bottle, Plastic",250,RC,61314-355-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Latanoprost: 1 Bottle In 1 Carton (61314-547-01)  / 2.5 Ml In 1 Bottle,250,RC,61314-547-01,NDC,,,facility,both,1,EA,,15.41,15.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prednisolone Acetate: 1 Bottle, Plastic In 1 Carton (61314-637-05)  / 5 Ml In 1 Bottle, Plastic",250,RC,61314-637-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prednisolone Acetate: 1 Bottle, Plastic In 1 Carton (61314-637-05)  / 5 Ml In 1 Bottle, Plastic",250,RC,61314-637-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neomycin And Polymyxin B Sulfates And Hydrocortisone: 7.5 Ml In 1 Bottle, Plastic (61314-641-75)",250,RC,61314-641-75,NDC,,,facility,both,1,EA,,266.36,266.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neomycin And Polymyxin B Sulfates And Hydrocortisone: 10 Ml In 1 Bottle, Plastic (61314-645-11)",250,RC,61314-645-11,NDC,,,facility,both,1,EA,,120.76,120.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tobramycin And Dexamethasone: 1 Bottle In 1 Carton (61314-647-25)  / 2.5 Ml In 1 Bottle,250,RC,61314-647-25,NDC,,,facility,both,1,EA,,54.85,54.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-656-25)  / 2.5 Ml In 1 Bottle, Plastic",250,RC,61314-656-25,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-656-25)  / 2.5 Ml In 1 Bottle, Plastic",250,RC,61314-656-25,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Apraclonidine: 5 Ml In 1 Bottle (61314-665-05),250,RC,61314-665-05,NDC,,,facility,both,1,EA,,116.1,116.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61553-136-02,NDC,,,facility,both,1,EA,,47.53,47.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61553-196-52,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61553-425-39,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-227-05)",250,RC,61314-227-05,NDC,,,facility,both,1,EA,,8.79,8.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-722-11,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-722-11,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxcarbazepine: 100 Blister Pack In 1 Carton (60687-722-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-722-11)",250,RC,60687-722-01,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-580-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-580-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-583-11,NDC,,,facility,both,1,EA,,4.87,4.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-583-11,NDC,,,facility,both,1,EA,,4.81,4.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-586-11,NDC,,,facility,both,1,EA,,3.37,3.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-586-11,NDC,,,facility,both,1,EA,,3.33,3.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-579-11,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-587-11,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-590-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-590-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-591-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-591-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-593-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-593-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-587-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-579-11,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-578-11,NDC,,,facility,both,1,EA,,6.87,6.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-550-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-552-11,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-555-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-555-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-556-33,NDC,,,facility,both,1,EA,,12.53,12.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-558-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Blister Pack In 1 Box, Unit-Dose (60687-559-01)  / 1 Tablet In 1 Blister Pack (60687-559-11)",250,RC,60687-559-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Blister Pack In 1 Box, Unit-Dose (60687-559-01)  / 1 Tablet In 1 Blister Pack (60687-559-11)",250,RC,60687-559-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-559-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-559-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-568-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-568-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-570-11,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-570-11,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-575-11,NDC,,,facility,both,1,EA,,5.76,5.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-576-03,NDC,,,facility,both,1,EA,,6.26,6.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-598-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-598-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-602-11,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-661-11,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-661-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-669-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-669-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-671-40,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-680-11,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-681-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-681-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-687-11,NDC,,,facility,both,1,EA,,5.55,5.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-690-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-690-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-693-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-693-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-704-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-711-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-660-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-657-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-602-11,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-607-11,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-607-11,NDC,,,facility,both,1,EA,,3.09,3.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-612-11,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-612-11,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-614-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-614-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-629-11,NDC,,,facility,both,1,EA,,5.97,5.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-629-11,NDC,,,facility,both,1,EA,,5.91,5.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01)  / 1 Tablet In 1 Blister Pack (60687-631-11)",250,RC,60687-631-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01)  / 1 Tablet In 1 Blister Pack (60687-631-11)",250,RC,60687-631-01,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-633-11,NDC,,,facility,both,1,EA,,5.32,5.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-633-11,NDC,,,facility,both,1,EA,,5.32,5.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-656-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-656-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,60687-657-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)",250,RC,61958-2002-1,NDC,,,facility,both,1,EA,,132.67,132.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam Hydrochloride: 118 mL in 1 BOTTLE, GLASS (63304-205-18) ",250,RC,63304-205-18,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (63304-458-30)",250,RC,63304-458-30,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Hydrochloride: 100 Capsule In 1 Bottle (63304-692-01),250,RC,63304-692-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (63304-772-01),250,RC,63304-772-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (63304-772-01),250,RC,63304-772-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir: 30 Tablet, Film Coated In 1 Bottle (63304-905-30)",250,RC,63304-905-30,NDC,,,facility,both,1,EA,,8.67,8.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-010-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Droxidopa: 90 Capsule In 1 Bottle (63304-086-90),250,RC,63304-086-90,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-010-03,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-012-03,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-013-01,NDC,,,facility,both,1,EA,,3.38,3.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gentamicin: 25 Vial In 1 Tray (63323-010-02)  / 2 Ml In 1 Vial (63323-010-01),250,RC,63323-010-02,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nuplazid: 30 Capsule In 1 Bottle, Plastic (63090-340-30)",250,RC,63090-340-30,NDC,,,facility,both,1,EA,,237.69,237.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nuplazid: 30 Capsule In 1 Bottle, Plastic (63090-340-30)",250,RC,63090-340-30,NDC,,,facility,both,1,EA,,237.69,237.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (62856-272-30),250,RC,62856-272-30,NDC,,,facility,both,1,EA,,35.32,35.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Banzel: 120 Tablet, Film Coated In 1 Bottle (62856-583-52)",250,RC,62856-583-52,NDC,,,facility,both,1,EA,,47.71,47.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63037-136-25,NDC,,,facility,both,1,EA,,6.56,6.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63037-137-25,NDC,,,facility,both,1,EA,,209.19,209.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63037-155-25,NDC,,,facility,both,1,EA,,8.34,8.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63037-164-25,NDC,,,facility,both,1,EA,,9.87,9.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63037-173-25,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63037-173-25,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)",250,RC,62756-797-88,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-044-00,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-130-02,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxy 100: 10 Vial In 1 Tray (63323-130-11)  / 10 Ml In 1 Vial (63323-130-02),250,RC,63323-130-11,NDC,,,facility,both,1,EA,,26.08,26.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-161-01)  / 1 Ml In 1 Vial, Single-Use (63323-161-00)",250,RC,63323-161-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-161-00,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-108-00,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Bicarbonate: 25 Vial, Single-Dose In 1 Tray (63323-089-50)  / 50 Ml In 1 Vial, Single-Dose (63323-089-25)",250,RC,63323-089-50,NDC,,,facility,both,1,EA,,44.19,44.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-093-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-093-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 25 Vial, Plastic In 1 Tray (63323-093-30)  / 30 Ml In 1 Vial, Plastic (63323-093-01)",250,RC,63323-093-30,NDC,,,facility,both,1,EA,,7.48,7.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-095-02,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-106-00,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-106-02,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-106-02,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate: 24 Bag In 1 Case (63323-106-05)  / 50 Ml In 1 Bag (63323-106-02),250,RC,63323-106-05,NDC,,,facility,both,1,EA,,3.32,3.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate: 24 Bag In 1 Case (63323-106-15)  / 500 Ml In 1 Bag,250,RC,63323-106-15,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,63323-108-00,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)",250,RC,62756-797-88,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Liothyronine Sodium: 100 Tablet In 1 Bottle (62756-589-88),250,RC,62756-589-88,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (62756-518-88),250,RC,62756-518-88,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 100 Ml In 1 Bottle (62135-712-42),250,RC,62135-712-42,NDC,,,facility,both,1,EA,,5.91,5.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 100 Ml In 1 Bottle (62135-712-42),250,RC,62135-712-42,NDC,,,facility,both,1,EA,,7.04,7.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Tablet, Film Coated, Extended Release In 1 Bottle (62175-262-37)",250,RC,62175-262-37,NDC,,,facility,both,1,EA,,3.85,3.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-310-37)",250,RC,62175-310-37,NDC,,,facility,both,1,EA,,5.96,5.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62327-444-04,NDC,,,facility,both,1,EA,,274.4,274.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62332-198-10,NDC,,,facility,both,1,EA,,5.04,5.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amantadine: 100 Capsule In 1 Bottle (62332-246-31),250,RC,62332-246-31,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amantadine: 100 Capsule In 1 Bottle (62332-246-31),250,RC,62332-246-31,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-364-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,62332-364-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-365-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,62332-365-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-366-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,62332-366-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-366-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,62332-366-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-367-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,62332-367-06,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir: 1 Carton In 1 Blister Pack (62332-415-10)  / 10 Capsule In 1 Carton,250,RC,62332-415-10,NDC,,,facility,both,1,EA,,13.8,13.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (62135-502-47),250,RC,62135-502-47,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (62135-502-47),250,RC,62135-502-47,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vemlidy: 30 Tablet In 1 Bottle, Plastic (61958-2301-1)",250,RC,61958-2301-1,NDC,,,facility,both,1,EA,,90.34,90.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)",250,RC,61958-2501-1,NDC,,,facility,both,1,EA,,254,254,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)",250,RC,61958-2501-1,NDC,,,facility,both,1,EA,,250.41,250.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Biktarvy: 30 Tablet In 1 Blister Pack (61958-2501-3),250,RC,61958-2501-3,NDC,,,facility,both,1,EA,,252.22,252.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 VIAL, SINGLE-DOSE in 1 CARTON (61958-2901-1)  / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE",250,RC,61958-2901-1,NDC,,,facility,both,1,EA,,889.2,889.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",250,RC,61958-2901-2,NDC,,,facility,both,1,EA,,12.58,12.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",250,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1244.33,1244.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",250,RC,61958-2901-2,NDC,,,facility,both,1,EA,,16.06,16.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,61990-0611-0,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cartia Xt: 90 Capsule, Extended Release In 1 Bottle (62037-598-90)",250,RC,62037-598-90,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cartia Xt: 90 Capsule, Extended Release In 1 Bottle (62037-598-90)",250,RC,62037-598-90,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-494-30)",250,RC,62332-494-30,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-495-30)",250,RC,62332-495-30,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-496-30)",250,RC,62332-496-30,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-496-30)",250,RC,62332-496-30,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (62559-390-20)  / 10 Capsule In 1 Blister Pack,250,RC,62559-390-20,NDC,,,facility,both,1,EA,,4.52,4.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (62559-390-20)  / 10 Capsule In 1 Blister Pack,250,RC,62559-390-20,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (62559-390-50),250,RC,62559-390-50,NDC,,,facility,both,1,EA,,2.76,2.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (62559-390-50),250,RC,62559-390-50,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythromycin Ethylsuccinate: 200 Ml In 1 Bottle (62559-440-02),250,RC,62559-440-02,NDC,,,facility,both,1,EA,,12.2,12.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62584-897-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62584-897-11,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62584-984-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62584-984-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Warfarin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (62584-994-01)  / 1 Tablet In 1 Blister Pack (62584-994-11)",250,RC,62584-994-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62584-994-11,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62584-994-11,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (62756-459-83),250,RC,62756-459-83,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (62756-460-83),250,RC,62756-460-83,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)",250,RC,61958-2002-1,NDC,,,facility,both,1,EA,,132.63,132.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Propafenone Hydrochloride: 100 Tablet, Coated In 1 Bottle (62559-231-01)",250,RC,62559-231-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Reglan: 100 Tablet In 1 Bottle, Plastic (62559-166-01)",250,RC,62559-166-01,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Moxifloxacin Ophthalmic Solution: 1 Bottle In 1 Carton (62332-505-03)  / 3 Ml In 1 Bottle,250,RC,62332-505-03,NDC,,,facility,both,1,EA,,18.07,18.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine And Prilocaine: 1 Tube In 1 Carton (62332-582-04)  / 5 G In 1 Tube,250,RC,62332-582-04,NDC,,,facility,both,1,EA,,14.94,14.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine And Prilocaine: 1 Tube In 1 Carton (62332-582-31)  / 30 G In 1 Tube,250,RC,62332-582-31,NDC,,,facility,both,1,EA,,40.93,40.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62332-599-01,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclophosphamide: 100 Capsule In 1 Bottle (62332-618-31),250,RC,62332-618-31,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (62332-724-35)",250,RC,62332-724-35,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (62332-724-35)",250,RC,62332-724-35,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62559-157-17,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,62559-157-17,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluvoxamine Maleate: 100 Tablet, Coated In 1 Bottle (62559-160-01)",250,RC,62559-160-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Reglan: 100 Tablet In 1 Bottle, Plastic (62559-166-01)",250,RC,62559-166-01,NDC,,,facility,both,1,EA,,6.77,6.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,ZZ1370-003430,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluorescite: 12 Vial In 1 Carton (0065-0092-65)  / 5 Ml In 1 Vial,250,RC,0065-0092-65,NDC,,,facility,both,1,EA,,62.32,62.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclomydril: 2 Ml In 1 Bottle, Plastic (0065-0359-02)",250,RC,0065-0359-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclogyl: 1 Bottle, Plastic In 1 Carton (0065-0395-15)  / 15 Ml In 1 Bottle, Plastic",250,RC,0065-0395-15,NDC,,,facility,both,1,EA,,166.18,166.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Systane: 1 Tube In 1 Carton (0065-0474-01)  / 10 G In 1 Tube,250,RC,0065-0474-01,NDC,,,facility,both,1,EA,,19.19,19.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Systane: 1 Tube In 1 Carton (0065-0474-01)  / 10 G In 1 Tube,250,RC,0065-0474-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Genteal Tears Night-Time: 1 Tube In 1 Carton (0065-0518-01)  / 3.5 G In 1 Tube,250,RC,0065-0518-01,NDC,,,facility,both,1,EA,,13.95,13.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Genteal Tears Night-Time: 1 Tube In 1 Carton (0065-0518-01)  / 3.5 G In 1 Tube,250,RC,0065-0518-01,NDC,,,facility,both,1,EA,,13.76,13.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tetracaine Hydrochloride: 12 Blister Pack In 1 Carton (0065-0741-14)  / 1 Bottle, Dropper In 1 Blister Pack / 4 Ml In 1 Bottle, Dropper",250,RC,0065-0741-14,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bss: 15 Ml In 1 Bottle (0065-0795-15),250,RC,0065-0795-15,NDC,,,facility,both,1,EA,,11.29,11.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rifadin Iv: 1 Vial, Glass In 1 Carton (0068-0597-01)  / 10 Ml In 1 Vial, Glass",250,RC,0068-0597-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-0059-04,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
1 VIAL in 1 CARTON (0069-0248-01)  / 100 mL in 1 VIAL,250,RC,0069-0248-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
COUMADIN: 1 BOTTLE in 1 CARTON (0056-0170-70)  / 100 TABLET in 1 BOTTLE,250,RC,0056-0170-70,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xeljanz: 60 Tablet, Film Coated In 1 Bottle (0069-1001-01)",250,RC,0069-1001-01,NDC,,,facility,both,1,EA,,174.23,174.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
COUMADIN: 1 BOTTLE in 1 CARTON (0056-0170-70)  / 100 TABLET in 1 BOTTLE,250,RC,0056-0170-70,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)",250,RC,0054-8526-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4181-25)",250,RC,0054-4181-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)",250,RC,0054-4183-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)",250,RC,0054-4183-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4184-25)",250,RC,0054-4184-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Blister Pack In 1 Carton (0054-8174-25)  / 1 Tablet In 1 Blister Pack,250,RC,0054-8174-25,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Blister Pack In 1 Carton (0054-8183-25)  / 1 Tablet In 1 Blister Pack,250,RC,0054-8183-25,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25)  / 10 Tablet In 1 Blister Pack,250,RC,0054-8297-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25)  / 10 Tablet In 1 Blister Pack,250,RC,0054-8297-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25)  / 10 Tablet In 1 Blister Pack,250,RC,0054-8299-25,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25)  / 10 Tablet In 1 Blister Pack,250,RC,0054-8299-25,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8301-25)  / 10 Tablet In 1 Blister Pack,250,RC,0054-8301-25,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8301-25)  / 10 Tablet In 1 Blister Pack,250,RC,0054-8301-25,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)",250,RC,0054-8526-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-5045-06,NDC,,,facility,both,1,EA,,90.11,90.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5045-30)  / 1 Kit In 1 Blister Pack (0069-5045-06)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1345-11)",250,RC,0069-5045-30,NDC,,,facility,both,1,EA,,90.11,90.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-5317-02,NDC,,,facility,both,1,EA,,131.27,131.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5317-20)  / 1 Kit In 1 Blister Pack (0069-5317-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-2085-11)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",250,RC,0069-5317-20,NDC,,,facility,both,1,EA,,135.2,135.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-5321-03,NDC,,,facility,both,1,EA,,89.26,89.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30)  / 1 Kit In 1 Blister Pack (0069-5321-03)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",250,RC,0069-5321-30,NDC,,,facility,both,1,EA,,87.51,87.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30)  / 1 Kit In 1 Blister Pack (0069-5321-03)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",250,RC,0069-5321-30,NDC,,,facility,both,1,EA,,89.81,89.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-6001-02,NDC,,,facility,both,1,EA,,36.54,36.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dilantin: 100 Capsule In 1 Bottle (0071-3740-66),250,RC,0071-3740-66,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zemplar: 25 Vial, Single-Dose In 1 Tray (0074-1658-01)  / 1 Ml In 1 Vial, Single-Dose",250,RC,0074-1658-01,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1306-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1306-01)",250,RC,0069-1306-10,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0069-1307-01,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1307-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1307-01)",250,RC,0069-1307-10,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Propranolol Hydrochloride: 500 Ml In 1 Bottle, Plastic (0054-3727-63)",250,RC,0054-3727-63,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 500 Ml In 1 Bottle (0054-3555-63),250,RC,0054-3555-63,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zoloft: 1 Bottle, Dropper In 1 Carton (0049-0050-01)  / 60 Ml In 1 Bottle, Dropper",250,RC,0049-0050-01,NDC,,,facility,both,1,EA,,10.7,10.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zoloft: 1 Bottle, Dropper In 1 Carton (0049-0050-01)  / 60 Ml In 1 Bottle, Dropper",250,RC,0049-0050-01,NDC,,,facility,both,1,EA,,16.64,16.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0049-0520-84,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pfizerpen: 1 Vial In 1 Carton (0049-0530-28)  / 1 Powder, For Solution In 1 Vial",250,RC,0049-0530-28,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Relpax: 12 Blister Pack In 1 Carton (0049-2340-05)  / 1 Tablet, Film Coated In 1 Blister Pack (0049-2340-79)",250,RC,0049-2340-05,NDC,,,facility,both,1,EA,,145.94,145.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vfend: 1 Vial, Single-Use In 1 Carton (0049-3190-01)  / 20 Ml In 1 Vial, Single-Use",250,RC,0049-3190-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vfend: 1 Vial, Single-Dose In 1 Carton (0049-3190-28)  / 20 Ml In 1 Vial, Single-Dose",250,RC,0049-3190-28,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vfend: 1 Vial, Single-Dose In 1 Carton (0049-3190-28)  / 20 Ml In 1 Vial, Single-Dose",250,RC,0049-3190-28,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitriol: 100 Capsule In 1 Bottle, Plastic (0054-0007-25)",250,RC,0054-0007-25,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0010-20)  / 1 Tablet In 1 Blister Pack,250,RC,0054-0010-20,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0010-20)  / 1 Tablet In 1 Blister Pack,250,RC,0054-0010-20,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0010-25),250,RC,0054-0010-25,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0010-25),250,RC,0054-0010-25,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 60 Tablet In 1 Bottle (0054-0011-21),250,RC,0054-0011-21,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 60 Tablet In 1 Bottle (0054-0011-21),250,RC,0054-0011-21,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21)  / 30 G In 1 Tube, With Applicator",250,RC,0046-0872-21,NDC,,,facility,both,1,EA,,821.32,821.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21)  / 30 G In 1 Tube, With Applicator",250,RC,0046-0872-21,NDC,,,facility,both,1,EA,,832.91,832.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Premarin: 1 Vial In 1 Carton (0046-0749-05)  / 5 Ml In 1 Vial,250,RC,0046-0749-05,NDC,,,facility,both,1,EA,,681.14,681.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Restasis: 30 Vial, Single-Use In 1 Tray (0023-9163-30)  / .4 Ml In 1 Vial, Single-Use",250,RC,0023-9163-30,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Restasis: 30 Vial, Single-Use In 1 Tray (0023-9163-30)  / .4 Ml In 1 Vial, Single-Use",250,RC,0023-9163-30,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Plaquenil: 100 TABLET, FILM COATED in 1 BOTTLE (0024-1562-10) ",250,RC,0024-1562-10,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Plaquenil: 100 TABLET, FILM COATED in 1 BOTTLE (0024-1562-10) ",250,RC,0024-1562-10,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Multaq: 60 Tablet, Film Coated In 1 Bottle (0024-4142-60)",250,RC,0024-4142-60,NDC,,,facility,both,1,EA,,23.92,23.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)",250,RC,0032-0045-70,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)",250,RC,0032-0045-70,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0046-70)",250,RC,0032-0046-70,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0047-70)",250,RC,0032-0047-70,NDC,,,facility,both,1,EA,,7.9,7.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0047-70)",250,RC,0032-0047-70,NDC,,,facility,both,1,EA,,8.15,8.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 1 Bottle In 1 Carton (0032-1203-70)  / 70 Capsule, Delayed Release In 1 Bottle",250,RC,0032-1203-70,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 1 Bottle In 1 Carton (0032-1203-70)  / 70 Capsule, Delayed Release In 1 Bottle",250,RC,0032-1203-70,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-2636-01)",250,RC,0032-2636-01,NDC,,,facility,both,1,EA,,16.03,16.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)",250,RC,0032-3016-13,NDC,,,facility,both,1,EA,,24.56,24.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)",250,RC,0032-3016-13,NDC,,,facility,both,1,EA,,24.43,24.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 250 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-28)",250,RC,0032-3016-28,NDC,,,facility,both,1,EA,,21.58,21.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Soma: 100 Tablet In 1 Bottle, Plastic (0037-2001-01)",250,RC,0037-2001-01,NDC,,,facility,both,1,EA,,20.33,20.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Proctofoam Hc: 1 Canister In 1 Carton (0037-6822-10)  / 10 G In 1 Canister,250,RC,0037-6822-10,NDC,,,facility,both,1,EA,,329.06,329.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Proctofoam Hc: 1 Canister In 1 Carton (0037-6822-10)  / 10 G In 1 Canister,250,RC,0037-6822-10,NDC,,,facility,both,1,EA,,331.86,331.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-0019-25)",250,RC,0054-0019-25,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Droxidopa: 90 CAPSULE in 1 BOTTLE (0054-0532-22) ,250,RC,0054-0532-22,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dicyclomine Hydrochloride: 473 Ml In 1 Bottle (0054-0622-63),250,RC,0054-0622-63,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0054-0660-25),250,RC,0054-0660-25,NDC,,,facility,both,1,EA,,4.94,4.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0709-20)  / 100 Tablet In 1 Blister Pack,250,RC,0054-0709-20,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0709-20)  / 100 Tablet In 1 Blister Pack,250,RC,0054-0709-20,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 1 Canister In 1 Carton (0054-0742-87)  / 200 Aerosol, Metered In 1 Canister",250,RC,0054-0742-87,NDC,,,facility,both,1,EA,,43.09,43.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyrazinamide: 60 Tablet In 1 Container (0054-0812-21),250,RC,0054-0812-21,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Capsule, Gelatin Coated In 1 Bottle (0054-2526-25)",250,RC,0054-2526-25,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Capsule, Gelatin Coated In 1 Bottle (0054-2527-25)",250,RC,0054-2527-25,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Capsule, Gelatin Coated In 1 Bottle (0054-2527-25)",250,RC,0054-2527-25,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitriol: 1 Bottle, Glass In 1 Carton (0054-3120-41)  / 15 Ml In 1 Bottle, Glass",250,RC,0054-3120-41,NDC,,,facility,both,1,EA,,34.51,34.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitriol: 1 Bottle, Glass In 1 Carton (0054-3120-41)  / 15 Ml In 1 Bottle, Glass",250,RC,0054-3120-41,NDC,,,facility,both,1,EA,,10.05,10.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Intensol: 30 Ml In 1 Bottle, Glass (0054-3176-44)",250,RC,0054-3176-44,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99)  / 120 Spray, Metered In 1 Bottle, Glass",250,RC,0054-3270-99,NDC,,,facility,both,1,EA,,15.35,15.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99)  / 120 Spray, Metered In 1 Bottle, Glass",250,RC,0054-3270-99,NDC,,,facility,both,1,EA,,15.33,15.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 60 Ml In 1 Bottle (0054-3294-46),250,RC,0054-3294-46,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 120 Ml In 1 Bottle (0054-3294-50),250,RC,0054-3294-50,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 50 Ml In 1 Bottle (0054-3505-47),250,RC,0054-3505-47,NDC,,,facility,both,1,EA,,72.33,72.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 15 Ml In 1 Bottle (0054-0517-41),250,RC,0054-0517-41,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Posaconazole: 1 Bottle, Glass In 1 Carton (0054-0449-49)  / 105 Ml In 1 Bottle, Glass",250,RC,0054-0449-49,NDC,,,facility,both,1,EA,,115.99,115.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 30 mL in 1 BOTTLE (0054-0404-44) ,250,RC,0054-0404-44,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle, Plastic (0054-0020-25)",250,RC,0054-0020-25,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle, Plastic (0054-0020-25)",250,RC,0054-0020-25,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle, Plastic (0054-0021-25)",250,RC,0054-0021-25,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle, Plastic (0054-0021-25)",250,RC,0054-0021-25,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 60 Ml In 1 Bottle (0054-0057-46),250,RC,0054-0057-46,NDC,,,facility,both,1,EA,,3.11,3.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 1 Bottle, Plastic In 1 Carton (0054-0062-58)  / 240 Ml In 1 Bottle, Plastic",250,RC,0054-0062-58,NDC,,,facility,both,1,EA,,5.92,5.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Torsemide: 100 Tablet In 1 Bottle, Plastic (0054-0077-25)",250,RC,0054-0077-25,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Exemestane: 30 Tablet, Film Coated In 1 Bottle (0054-0080-13)",250,RC,0054-0080-13,NDC,,,facility,both,1,EA,,19.63,19.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0054-0163-25),250,RC,0054-0163-25,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (0054-0176-13),250,RC,0054-0176-13,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Quetiapine Fumarate: 100 Tablet In 1 Bottle (0054-0221-25),250,RC,0054-0221-25,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63),250,RC,0054-0237-63,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63),250,RC,0054-0237-63,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24)  / 10 Tablet In 1 Blister Pack,250,RC,0054-0243-24,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24)  / 10 Tablet In 1 Blister Pack,250,RC,0054-0243-24,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluticasone Propionate And Salmeterol: 1 Pouch In 1 Carton (0054-0328-56)  / 1 Inhaler In 1 Pouch / 60 Powder In 1 Inhaler,250,RC,0054-0328-56,NDC,,,facility,both,1,EA,,3.67,3.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 473 Ml In 1 Bottle (0054-0386-63),250,RC,0054-0386-63,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1000 Ml In 1 Bottle (0054-0391-68),250,RC,0054-0391-68,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 30 mL in 1 BOTTLE (0054-0393-44) ,250,RC,0054-0393-44,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",250,RC,0023-6082-10,NDC,,,facility,both,1,EA,,31.57,31.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rinvoq: 30 Tablet, Extended Release In 1 Bottle (0074-2306-30)",250,RC,0074-2306-30,NDC,,,facility,both,1,EA,,395.39,395.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose: 30 Ml In 1 Cup, Unit-Dose (0116-4005-30)",250,RC,0116-4005-30,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-0431-30,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-0431-30,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0489-05,NDC,,,facility,both,1,EA,,7.3,7.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0489-05,NDC,,,facility,both,1,EA,,9.1,9.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0489-05,NDC,,,facility,both,1,EA,,7.3,7.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Haloperidol: 10 Tray In 1 Case (0121-0581-05)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose",250,RC,0121-0581-05,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0638-05,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0638-05,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amantadine Hydrochloride: 10 Tray In 1 Case (0121-0646-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",250,RC,0121-0646-10,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amantadine Hydrochloride: 10 Tray In 1 Case (0121-0646-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",250,RC,0121-0646-10,NDC,,,facility,both,1,EA,,6.37,6.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valproic Acid: 473 Ml In 1 Bottle (0121-0675-85),250,RC,0121-0675-85,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 473 Ml In 1 Bottle (0121-0678-16),250,RC,0121-0678-16,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 473 Ml In 1 Bottle (0121-0678-16),250,RC,0121-0678-16,NDC,,,facility,both,1,EA,,5.87,5.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle (0121-0759-08),250,RC,0121-0759-08,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Carbonate: 12 Bottle In 1 Case (0121-0766-16)  / 473 Ml In 1 Bottle,250,RC,0121-0766-16,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Carbonate: 12 Bottle In 1 Case (0121-0766-16)  / 473 Ml In 1 Bottle,250,RC,0121-0766-16,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose: 30 Ml In 1 Cup, Unit-Dose (0116-4005-30)",250,RC,0116-4005-30,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorhexidine Gluconate: 473 Ml In 1 Bottle (0116-2001-16),250,RC,0116-2001-16,NDC,,,facility,both,1,EA,,3.69,3.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-7295-01)",250,RC,0093-7295-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 500 Tablet, Film Coated In 1 Bottle (0093-7296-05)",250,RC,0093-7296-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venlafaxine Hydrochloride: 30 Capsule, Extended Release In 1 Bottle (0093-7385-56)",250,RC,0093-7385-56,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (0093-7385-98)",250,RC,0093-7385-98,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (0093-7385-98)",250,RC,0093-7385-98,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glyburide: 100 Tablet In 1 Bottle (0093-8343-01),250,RC,0093-8343-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glyburide: 100 Tablet In 1 Bottle (0093-8344-01),250,RC,0093-8344-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (0093-8739-01),250,RC,0093-8739-01,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Venlafaxine Hydrochloride: 100 Tablet In 1 Bottle (0093-9147-01),250,RC,0093-9147-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Venlafaxine Hydrochloride: 100 Tablet In 1 Bottle (0093-9147-01),250,RC,0093-9147-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0093-9293-19,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (0093-9701-01),250,RC,0093-9701-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyridostigmine Bromide: 100 Tablet In 1 Bottle (0115-3511-01),250,RC,0115-3511-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyridostigmine Bromide: 100 Tablet In 1 Bottle (0115-3511-01),250,RC,0115-3511-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dantrolene Sodium: 100 Capsule In 1 Bottle (0115-4411-01),250,RC,0115-4411-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dantrolene Sodium: 100 Capsule In 1 Bottle (0115-4411-01),250,RC,0115-4411-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fludrocortisone Acetate: 100 Tablet In 1 Bottle (0115-7033-01),250,RC,0115-7033-01,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fludrocortisone Acetate: 100 Tablet In 1 Bottle (0115-7033-01),250,RC,0115-7033-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorhexidine Gluconate: 473 Ml In 1 Bottle (0116-2001-16),250,RC,0116-2001-16,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-7295-01)",250,RC,0093-7295-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 1 Bottle, Dropper In 1 Carton (0121-0770-01)  / 30 Ml In 1 Bottle, Dropper",250,RC,0121-0770-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 1 Tray In 1 Case (0121-1012-95)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1012-05)",250,RC,0121-1012-95,NDC,,,facility,both,1,EA,,45.58,45.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1016-05,NDC,,,facility,both,1,EA,,44.4,44.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1016-05,NDC,,,facility,both,1,EA,,44.5,44.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 473 Ml In 1 Bottle (0121-1045-16),250,RC,0121-1045-16,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose: 10 Tray In 1 Case (0121-1154-00)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose (0121-1154-30)",250,RC,0121-1154-00,NDC,,,facility,both,1,EA,,2.65,2.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose: 10 Tray In 1 Case (0121-1154-00)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose (0121-1154-30)",250,RC,0121-1154-00,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1154-30,NDC,,,facility,both,1,EA,,2.64,2.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1154-30,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose: 4 Tray In 1 Case (0121-1154-40)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose (0121-1154-30)",250,RC,0121-1154-40,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1488-10,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1488-10,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",250,RC,0121-1576-10,NDC,,,facility,both,1,EA,,5.85,5.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",250,RC,0121-1576-10,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-1761-30,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-1761-30,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1775-05,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1775-05,NDC,,,facility,both,1,EA,,4.88,4.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Childrens Acetaminophen: 10 Tray In 1 Case (0121-1781-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1781-05)",250,RC,0121-1781-00,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 1 Bottle, Dropper In 1 Carton (0121-0770-01)  / 30 Ml In 1 Bottle, Dropper",250,RC,0121-0770-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1012-05,NDC,,,facility,both,1,EA,,44.99,44.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 60 Ml In 1 Bottle, Dropper (0121-0868-02)",250,RC,0121-0868-02,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0868-05,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0868-05,NDC,,,facility,both,1,EA,,3.31,3.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 473 Ml In 1 Bottle (0121-0868-16),250,RC,0121-0868-16,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactulose: 473 Ml In 1 Bottle (0121-0873-16),250,RC,0121-0873-16,NDC,,,facility,both,1,EA,,12.35,12.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0904-05,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0904-05,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0905-05,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0905-05,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0945-10,NDC,,,facility,both,1,EA,,6.21,6.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 473 Ml In 1 Bottle (0121-0948-16),250,RC,0121-0948-16,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 12 Bottle In 1 Case (0121-0950-03)  / 100 Ml In 1 Bottle,250,RC,0121-0950-03,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 12 Bottle In 1 Case (0121-0950-03)  / 100 Ml In 1 Bottle,250,RC,0121-0950-03,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 1 Bottle, Glass In 1 Carton (0121-0972-51)  / 50 Ml In 1 Bottle, Glass",250,RC,0121-0972-51,NDC,,,facility,both,1,EA,,28.19,28.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0974-10,NDC,,,facility,both,1,EA,,12.39,12.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0974-10,NDC,,,facility,both,1,EA,,11.49,11.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-0978-10,NDC,,,facility,both,1,EA,,3.74,3.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1012-05,NDC,,,facility,both,1,EA,,45.58,45.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 30 Capsule, Delayed Release In 1 Bottle (0093-6451-56)",250,RC,0093-6451-56,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Erythromycin: 100 Tablet, Film Coated In 1 Bottle (0093-5571-01)",250,RC,0093-5571-01,NDC,,,facility,both,1,EA,,11.96,11.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciloxan: 3.5 G In 1 Tube (0078-0841-01),250,RC,0078-0841-01,NDC,,,facility,both,1,EA,,491.32,491.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tobradex: 3.5 G In 1 Tube (0078-0876-01),250,RC,0078-0876-01,NDC,,,facility,both,1,EA,,538.75,538.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mekinist: 30 Tablet, Film Coated In 1 Bottle (0078-1105-15)",250,RC,0078-1105-15,NDC,,,facility,both,1,EA,,327.9,327.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Noxafil: 1 Bottle, Glass In 1 Carton (0085-1328-01)  / 105 Ml In 1 Bottle, Glass",250,RC,0085-1328-01,NDC,,,facility,both,1,EA,,126.43,126.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0088-2102-01,NDC,,,facility,both,1,EA,,8.97,8.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass",250,RC,0088-2220-33,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass",250,RC,0088-2220-33,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0051-01)",250,RC,0093-0051-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0051-01)",250,RC,0093-0051-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01),250,RC,0093-0053-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01),250,RC,0093-0053-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0135-01)",250,RC,0093-0135-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0135-01)",250,RC,0093-0135-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa and Levodopa: 100 TABLET in 1 BOTTLE (0093-0294-01) ,250,RC,0093-0294-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet,250,RC,0074-3663-03,NDC,,,facility,both,1,EA,,3255.2,3255.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Synthroid: 1000 Tablet In 1 Bottle (0074-4341-19),250,RC,0074-4341-19,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Synthroid: 1000 Tablet In 1 Bottle (0074-4341-19),250,RC,0074-4341-19,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11)  / 10 Tablet In 1 Blister Pack",250,RC,0074-7148-11,NDC,,,facility,both,1,EA,,3,3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11)  / 10 Tablet In 1 Blister Pack",250,RC,0074-7148-11,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0075-0620-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0075-0622-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0078-0501-61,NDC,,,facility,both,1,EA,,41.33,41.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0078-0501-61,NDC,,,facility,both,1,EA,,41.2,41.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Coartem: 24 Tablet In 1 Bottle (0078-0568-45),250,RC,0078-0568-45,NDC,,,facility,both,1,EA,,10.15,10.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)",250,RC,0078-0659-20,NDC,,,facility,both,1,EA,,17.46,17.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)",250,RC,0078-0659-20,NDC,,,facility,both,1,EA,,18.32,18.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tafinlar: 120 Capsule In 1 Bottle (0078-0681-66),250,RC,0078-0681-66,NDC,,,facility,both,1,EA,,256.97,256.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Promacta: 30 Tablet, Film Coated In 1 Bottle (0078-0685-15)",250,RC,0078-0685-15,NDC,,,facility,both,1,EA,,511.33,511.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0696-20)",250,RC,0078-0696-20,NDC,,,facility,both,1,EA,,20.94,20.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)",250,RC,0078-0777-20,NDC,,,facility,both,1,EA,,20.8,20.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)",250,RC,0078-0777-20,NDC,,,facility,both,1,EA,,20.88,20.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loperamide Hydrochloride: 100 Capsule In 1 Bottle (0093-0311-01),250,RC,0093-0311-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loperamide Hydrochloride: 100 Capsule In 1 Bottle (0093-0311-01),250,RC,0093-0311-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),250,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),250,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),250,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),250,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),250,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),250,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sucralfate: 100 Tablet In 1 Bottle (0093-2210-01),250,RC,0093-2210-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sucralfate: 100 Tablet In 1 Bottle (0093-2210-01),250,RC,0093-2210-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sucralfate: 90 Tablet In 1 Bottle (0093-2210-98),250,RC,0093-2210-98,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Capsule In 1 Bottle (0093-3107-01),250,RC,0093-3107-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate Hfa: 1 Inhaler In 1 Carton (0093-3174-31)  / 200 Aerosol, Metered In 1 Inhaler",250,RC,0093-3174-31,NDC,,,facility,both,1,EA,,65.05,65.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",250,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",250,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3426-01)",250,RC,0093-3426-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 1000 Tablet In 1 Bottle, Plastic (0093-3426-10)",250,RC,0093-3426-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0093-5245-19,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cabergoline: 1 Bottle In 1 Carton (0093-5420-88)  / 8 Tablet In 1 Bottle,250,RC,0093-5420-88,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Liothyronine Sodium: 100 Tablet In 1 Bottle (0093-2179-01),250,RC,0093-2179-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Liothyronine Sodium: 100 Tablet In 1 Bottle (0093-2179-01),250,RC,0093-2179-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cilostazol: 60 Tablet In 1 Bottle (0093-2065-06),250,RC,0093-2065-06,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0318-01)",250,RC,0093-0318-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0318-01)",250,RC,0093-0318-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pravastatin Sodium: 90 Tablet In 1 Bottle (0093-0771-98),250,RC,0093-0771-98,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pravastatin Sodium: 90 Tablet In 1 Bottle (0093-0771-98),250,RC,0093-0771-98,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0810-01),250,RC,0093-0810-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0810-01),250,RC,0093-0810-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 500 Capsule In 1 Bottle (0093-0810-05),250,RC,0093-0810-05,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 500 Capsule In 1 Bottle (0093-0810-05),250,RC,0093-0810-05,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01),250,RC,0093-0811-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01),250,RC,0093-0811-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01),250,RC,0093-0812-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01),250,RC,0093-0812-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Tablet In 1 Bottle (0093-0832-01),250,RC,0093-0832-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (0093-1010-42)  / 22 G In 1 Tube,250,RC,0093-1010-42,NDC,,,facility,both,1,EA,,11,11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (0093-1010-42)  / 22 G In 1 Tube,250,RC,0093-1010-42,NDC,,,facility,both,1,EA,,10.71,10.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sotalol Hydrochloride: 100 Tablet In 1 Bottle (0093-1061-01),250,RC,0093-1061-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neomycin Sulfate: 100 Tablet In 1 Bottle (0093-1177-01),250,RC,0093-1177-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cilostazol: 60 Tablet In 1 Bottle (0093-2064-06),250,RC,0093-2064-06,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cilostazol: 60 Tablet In 1 Bottle (0093-2064-06),250,RC,0093-2064-06,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cilostazol: 60 Tablet In 1 Bottle (0093-2065-06),250,RC,0093-2065-06,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026886011,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5093009808,NDC,,,facility,both,1,EA,,20.3,20.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5093009808,NDC,,,facility,both,1,EA,,20.31,20.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5155200556,NDC,,,facility,both,1,EA,,15.02,15.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5192712020,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5483800650,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5777100704,NDC,,,facility,both,1,EA,,13.06,13.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5789645101,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5789645101,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5789687503,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5789687503,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5865717001,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5865717001,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026886011,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5865731216,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885911,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4009310287,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4203710478,NDC,,,facility,both,1,EA,,9.79,9.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4203710478,NDC,,,facility,both,1,EA,,9.69,9.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4329255857,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4467710202,NDC,,,facility,both,1,EA,,213.94,213.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4601701816,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4601701816,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,4843310401,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5019014263,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026818311,NDC,,,facility,both,1,EA,,4.74,4.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026852411,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026852411,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026858211,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885211,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885211,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885311,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885311,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885811,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885811,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5026885911,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3877905108,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,5898096012,NDC,,,facility,both,1,EA,,31.4,31.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6025800615,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6936725001,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6936725001,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6936726701,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6936728302,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6936728302,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6961807059,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7135101001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7135101099,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7139974015,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7139974805,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7214045231,NDC,,,facility,both,1,EA,,9.36,9.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7214045231,NDC,,,facility,both,1,EA,,9.39,9.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7583401060,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7583401060,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7628045931,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733343025,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733343025,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733393810,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733393810,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733393825,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6936722001,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6025800615,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6817600015,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6025816001,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6025816001,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6253000011,NDC,,,facility,both,1,EA,,6.99,6.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6253000011,NDC,,,facility,both,1,EA,,7.09,7.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6332325410,NDC,,,facility,both,1,EA,,38.37,38.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6373612002,NDC,,,facility,both,1,EA,,14.16,14.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6425333333,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6498010401,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6498010401,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6498033901,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6498033901,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6498033990,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6498033990,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6809422401,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6817600010,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6817600011,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6817600011,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,6817600015,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3877905108,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3660219209,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,536440601,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,536440601,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,536730001,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,536730001,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,573051330,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,573051330,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,573475652,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,573475652,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574006915,NDC,,,facility,both,1,EA,,6.18,6.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574007015,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574030316,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574030416,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574030416,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574031116,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,574031116,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,884629730,NDC,,,facility,both,1,EA,,8.24,8.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904052360,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904052360,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904052361,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904052361,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,536344308,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904053061,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,487900360,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4277-17)",250,RC,0409-4277-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,87040203,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,87040501,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,87086644,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,121053005,NDC,,,facility,both,1,EA,,3.73,3.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,121053005,NDC,,,facility,both,1,EA,,3.46,3.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,121067616,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,121119030,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,121119030,NDC,,,facility,both,1,EA,,7.14,7.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,132030140,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,132030140,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,225055050,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,395266116,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,395266116,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,395266216,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,486112501,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,486112501,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,487900330,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,487900330,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,536134480,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904053061,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904208560,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,1802985005,NDC,,,facility,both,1,EA,,6.89,6.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055500100,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055500100,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055501900,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055501900,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055502700,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055502700,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055503300,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055503300,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055503601,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2055503601,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2159934562,NDC,,,facility,both,1,EA,,3,3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,2159934564,NDC,,,facility,both,1,EA,,14.84,14.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3010304000,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3172213747,NDC,,,facility,both,1,EA,,5.53,5.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3172213747,NDC,,,facility,both,1,EA,,5.43,5.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3660207917,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,3660219209,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,1785600102,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,1785600102,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,1093995959,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904208560,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904227260,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904227260,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904421551,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904522452,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904522452,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904549261,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904549261,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904582360,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904582360,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904582493,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904582493,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733393825,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904598463,NDC,,,facility,both,1,EA,,8.6,8.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904719106,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904719106,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904759160,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904759160,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904759161,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904759161,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904775127,NDC,,,facility,both,1,EA,,6.04,6.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,1093995959,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,904598463,NDC,,,facility,both,1,EA,,8.62,8.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733394810,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733394810,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-5423-02,NDC,,,facility,both,1,EA,,231.59,231.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-5425-05,NDC,,,facility,both,1,EA,,416.87,416.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bridion: 10 Vial, Single-Dose In 1 Carton (0006-5425-15)  / 5 Ml In 1 Vial, Single-Dose (0006-5425-05)",250,RC,0006-5425-15,NDC,,,facility,both,1,EA,,182.07,182.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"COREG: 100 TABLET, FILM COATED in 1 BOTTLE (0007-4142-20) ",250,RC,0007-4142-20,NDC,,,facility,both,1,EA,,12.42,12.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Protonix I.V.: 1 Vial In 1 Carton (0008-0923-51)  / 10 Ml In 1 Vial,250,RC,0008-0923-51,NDC,,,facility,both,1,EA,,4.71,4.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pristiq Extended-Release: 90 Tablet, Extended Release In 1 Bottle, Plastic (0008-1222-01)",250,RC,0008-1222-01,NDC,,,facility,both,1,EA,,26.39,26.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0011-03,NDC,,,facility,both,1,EA,,8.61,8.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0011-03,NDC,,,facility,both,1,EA,,20.48,20.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial,250,RC,0009-0018-20,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-5423-02,NDC,,,facility,both,1,EA,,222.9,222.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-5423-02,NDC,,,facility,both,1,EA,,212.35,212.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-0277-01,NDC,,,facility,both,1,EA,,20.12,20.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-0277-01,NDC,,,facility,both,1,EA,,19.64,19.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0277-31)",250,RC,0006-0277-31,NDC,,,facility,both,1,EA,,21.6,21.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0277-31)",250,RC,0006-0277-31,NDC,,,facility,both,1,EA,,19.88,19.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)",250,RC,0006-3069-01,NDC,,,facility,both,1,EA,,110.82,110.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)",250,RC,0006-3069-01,NDC,,,facility,both,1,EA,,109.96,109.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-3075-01,NDC,,,facility,both,1,EA,,537.81,537.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-4681-01,NDC,,,facility,both,1,EA,,172.24,172.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00)  / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)",250,RC,0006-4827-00,NDC,,,facility,both,1,EA,,340.83,340.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-4897-01,NDC,,,facility,both,1,EA,,52.54,52.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.63,12.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,0023-1145-01,NDC,,,facility,both,1,EA,,11.05,11.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Refresh Celluvisc: 30 Vial, Single-Use In 1 Carton (0023-4554-30)  / .4 Ml In 1 Vial, Single-Use",250,RC,0023-4554-30,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0023-6082-01,NDC,,,facility,both,1,EA,,29.62,29.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
R-Gene: 1 Container In 1 Carton (0009-0436-01)  / 300 Ml In 1 Container,250,RC,0009-0436-01,NDC,,,facility,both,1,EA,,8.49,8.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Cortef: 1 Vial In 1 Carton (0009-0825-01)  / 2 Ml In 1 Vial,250,RC,0009-0825-01,NDC,,,facility,both,1,EA,,27.98,27.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hemabate: 10 Ampule In 1 Package (0009-0856-08)  / 1 Ml In 1 Ampule (0009-0856-05),250,RC,0009-0856-08,NDC,,,facility,both,1,EA,,241.3,241.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isentress: 60 Tablet, Film Coated In 1 Bottle (0006-0227-61)",250,RC,0006-0227-61,NDC,,,facility,both,1,EA,,62.51,62.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-3169-01,NDC,,,facility,both,1,EA,,93.67,93.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aromasin: 30 Tablet In 1 Bottle (0009-7663-04),250,RC,0009-7663-04,NDC,,,facility,both,1,EA,,69.34,69.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0009-7807-01,NDC,,,facility,both,1,EA,,11.63,11.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0013-1114-20,NDC,,,facility,both,1,EA,,12.55,12.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Refresh Lacri-Lube: 1 Tube In 1 Carton (0023-0312-04)  / 3.5 G In 1 Tube,250,RC,0023-0312-04,NDC,,,facility,both,1,EA,,19.15,19.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Refresh Lacri-Lube: 1 Tube In 1 Carton (0023-0312-04)  / 3.5 G In 1 Tube,250,RC,0023-0312-04,NDC,,,facility,both,1,EA,,19.15,19.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1781-05,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Januvia: 100 Blister Pack In 1 Carton (0006-0221-28)  / 1 Tablet, Film Coated In 1 Blister Pack (0006-0221-01)",250,RC,0006-0221-28,NDC,,,facility,both,1,EA,,24.62,24.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-0221-01,NDC,,,facility,both,1,EA,,20.81,20.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068116900,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8137003640,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8290306423,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8290306547,NDC,,,facility,both,1,EA,,8.24,8.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8290306547,NDC,,,facility,both,1,EA,,8.24,8.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8770140065,NDC,,,facility,both,1,EA,,3.88,3.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9468808470,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9468818470,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9468818470,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9697400005,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,9697400005,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,97344038787,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,97344038787,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-0213-01)  / 3 Ml In 1 Vial, Multi-Dose",250,RC,0002-0213-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Strattera: 30 Capsule In 1 Bottle (0002-3227-30),250,RC,0002-3227-30,NDC,,,facility,both,1,EA,,23.83,23.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Strattera: 30 Capsule In 1 Bottle (0002-3228-30),250,RC,0002-3228-30,NDC,,,facility,both,1,EA,,23.82,23.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068116900,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068116500,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733394825,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733394825,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733395125,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733395125,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733398310,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733398325,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7733398325,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7811200068,NDC,,,facility,both,1,EA,,7.93,7.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,7811201103,NDC,,,facility,both,1,EA,,8.68,8.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068104900,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068104900,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068105700,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068107100,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068109700,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068109800,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068109800,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068111600,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068111600,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068115500,NDC,,,facility,both,1,EA,,3.76,3.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068115500,NDC,,,facility,both,1,EA,,3.76,3.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,8068116500,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01)  / 10 Ml In 1 Vial, Multi-Dose",250,RC,0002-8215-01,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azactam: 10 Vial, Single-Dose In 1 Carton (0003-2570-16)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",250,RC,0003-2570-16,NDC,,,facility,both,1,EA,,5.37,5.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valcyte: 1 Bottle, Glass In 1 Carton (0004-0039-09)  / 100 Ml In 1 Bottle, Glass",250,RC,0004-0039-09,NDC,,,facility,both,1,EA,,12.63,12.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tamiflu: 1 Blister Pack In 1 Carton (0004-0802-85)  / 10 Capsule In 1 Blister Pack,250,RC,0004-0802-85,NDC,,,facility,both,1,EA,,25.19,25.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamiflu: 1 Bottle, Glass In 1 Carton (0004-0822-05)  / 60 Ml In 1 Bottle, Glass",250,RC,0004-0822-05,NDC,,,facility,both,1,EA,,45.75,45.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0005-2000-01,NDC,,,facility,both,1,EA,,439.38,439.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02)  / .5 Ml In 1 Syringe (0005-2000-01),250,RC,0005-2000-02,NDC,,,facility,both,1,EA,,444.7,444.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"PROPECIA: 30 TABLET, FILM COATED in 1 BOTTLE (0006-0071-31) ",250,RC,0006-0071-31,NDC,,,facility,both,1,EA,,6.07,6.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-0112-01,NDC,,,facility,both,1,EA,,19.88,19.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-0112-01,NDC,,,facility,both,1,EA,,21.93,21.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0006-0221-01,NDC,,,facility,both,1,EA,,20.58,20.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-0050-60)",250,RC,0003-0050-60,NDC,,,facility,both,1,EA,,54.01,54.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0003-0893-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0003-0893-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0003-0894-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0003-0894-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-1100-60)",250,RC,0003-1100-60,NDC,,,facility,both,1,EA,,54.01,54.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baraclude: 1 Bottle In 1 Carton (0003-1614-12)  / 210 Ml In 1 Bottle,250,RC,0003-1614-12,NDC,,,facility,both,1,EA,,82.68,82.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mag-Al Plus Xs: 10 Tray In 1 Case (0121-1762-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-1762-30,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1870-10,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1805-77)",250,RC,0378-1805-77,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1805-77)",250,RC,0378-1805-77,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1809-77)",250,RC,0378-1809-77,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1809-77)",250,RC,0378-1809-77,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1811-77)",250,RC,0378-1811-77,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1811-77)",250,RC,0378-1811-77,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1813-77)",250,RC,0378-1813-77,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1813-77)",250,RC,0378-1813-77,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-2146-01)",250,RC,0378-2146-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-2146-01)",250,RC,0378-2146-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Captopril: 100 TABLET in 1 BOTTLE, PLASTIC (0378-3012-01) ",250,RC,0378-3012-01,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fenofibrate: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-3066-77)",250,RC,0378-3066-77,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fenofibrate: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-3066-77)",250,RC,0378-3066-77,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prazosin Hydrochloride: 100 Capsule In 1 Bottle, Plastic (0378-3205-01)",250,RC,0378-3205-01,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (0378-3979-93) ",250,RC,0378-3979-93,NDC,,,facility,both,1,EA,,20.36,20.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Abacavir Sulfate: 1 Bottle, Plastic In 1 Carton (0378-4105-91)  / 60 Tablet, Film Coated In 1 Bottle, Plastic",250,RC,0378-4105-91,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-4640-16,NDC,,,facility,both,1,EA,,13.13,13.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5813-77)",250,RC,0378-5813-77,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5813-77)",250,RC,0378-5813-77,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1800-77)",250,RC,0378-1800-77,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 500 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-05)",250,RC,0378-0018-05,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 500 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-05)",250,RC,0378-0018-05,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0047-01)",250,RC,0378-0047-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0047-01)",250,RC,0378-0047-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle, Plastic (0378-0085-01)",250,RC,0378-0085-01,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle, Plastic (0378-0085-01)",250,RC,0378-0085-01,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (0378-0137-01),250,RC,0378-0137-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (0378-0137-01),250,RC,0378-0137-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Propranolol Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-0182-01)",250,RC,0378-0182-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorthalidone: 100 Tablet In 1 Bottle, Plastic (0378-0222-01)",250,RC,0378-0222-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-0771-01) ",250,RC,0378-0771-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-0771-01) ",250,RC,0378-0771-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clozapine: 100 Tablet In 1 Bottle, Plastic (0378-0825-01)",250,RC,0378-0825-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-0871-16,NDC,,,facility,both,1,EA,,23.85,23.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-0872-16,NDC,,,facility,both,1,EA,,38.56,38.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-0873-16,NDC,,,facility,both,1,EA,,52.57,52.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle, Plastic (0378-1133-01)",250,RC,0378-1133-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-1150-01)",250,RC,0378-1150-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Buspirone Hydrochloride: 500 Tablet In 1 Bottle, Plastic (0378-1150-05)",250,RC,0378-1150-05,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Buspirone Hydrochloride: 500 Tablet In 1 Bottle, Plastic (0378-1150-05)",250,RC,0378-1150-05,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1800-77)",250,RC,0378-1800-77,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5814-77)",250,RC,0378-5814-77,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5815-77)",250,RC,0378-5815-77,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9125-16,NDC,,,facility,both,1,EA,,76.72,76.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9125-16,NDC,,,facility,both,1,EA,,74.05,74.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Wixela Inhub: 1 Inhaler In 1 Carton (0378-9322-32)  / 60 Powder In 1 Inhaler,250,RC,0378-9322-32,NDC,,,facility,both,1,EA,,3.7,3.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Benzoin Compound Tincture: 59 Ml In 1 Bottle, Plastic (0395-0243-92)",250,RC,0395-0243-92,NDC,,,facility,both,1,EA,,15.73,15.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Benzoin Compound Tincture: 59 Ml In 1 Bottle, Plastic (0395-0243-92)",250,RC,0395-0243-92,NDC,,,facility,both,1,EA,,6.88,6.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0395-1031-16,NDC,,,facility,both,1,EA,,4.94,4.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0395-1031-16,NDC,,,facility,both,1,EA,,4.37,4.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0395-1031-96,NDC,,,facility,both,1,EA,,4.22,4.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0395-1031-96,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Iodine And Potassium Iodide: 473 Ml In 1 Bottle, Plastic (0395-2775-16)",250,RC,0395-2775-16,NDC,,,facility,both,1,EA,,4.56,4.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)",250,RC,0406-0527-10,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)",250,RC,0406-0527-10,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),250,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),250,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1142-01),250,RC,0406-1142-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1142-01),250,RC,0406-1142-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naltrexone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (0406-1170-03)",250,RC,0406-1170-03,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01),250,RC,0406-1236-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9122-16,NDC,,,facility,both,1,EA,,18.32,18.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5815-77)",250,RC,0378-5815-77,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9122-16,NDC,,,facility,both,1,EA,,18.32,18.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9116-16,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acamprosate Calcium: 180 Tablet, Delayed Release In 1 Bottle, Plastic (0378-6333-80)",250,RC,0378-6333-80,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-6470-16,NDC,,,facility,both,1,EA,,33.22,33.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8270-31,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8760-98,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8760-98,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8766-16,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8767-16,NDC,,,facility,both,1,EA,,6.49,6.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8768-16,NDC,,,facility,both,1,EA,,11.41,11.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-8768-16,NDC,,,facility,both,1,EA,,11.51,11.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9070-16,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9070-16,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9071-16,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9071-16,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9072-16,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9102-16,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9104-16,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitroglycerin: 30 Pouch In 1 Carton (0378-9104-93)  / 1 Patch In 1 Pouch (0378-9104-16)  / 14 H In 1 Patch,250,RC,0378-9104-93,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0378-9119-16,NDC,,,facility,both,1,EA,,21.75,21.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)",250,RC,0378-0018-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)",250,RC,0378-0018-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmedetomidine Hydrochloride: 12 Bag In 1 Carton (0338-9557-12)  / 100 Ml In 1 Bag,250,RC,0338-9557-12,NDC,,,facility,both,1,EA,,29.48,29.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag,250,RC,0338-0049-11,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag,250,RC,0338-0049-18,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Bag In 1 Package (0338-0049-31)  / 50 Ml In 1 Bag,250,RC,0338-0049-31,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Bag In 1 Package (0338-0049-38)  / 100 Ml In 1 Bag,250,RC,0338-0049-38,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1 Bag In 1 Package (0338-0049-48)  / 100 Ml In 1 Bag,250,RC,0338-0049-48,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Bag In 1 Carton (0338-0054-03)  / 500 Ml In 1 Bag,250,RC,0338-0054-03,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 10 Vial In 1 Carton (0338-0069-10)  / 1 Ml In 1 Vial,250,RC,0338-0069-10,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial,250,RC,0338-0072-25,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0077-04)  / 1000 Ml In 1 Bag,250,RC,0338-0077-04,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0085-04)  / 1000 Ml In 1 Bag,250,RC,0338-0085-04,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0089-04)  / 1000 Ml In 1 Bag,250,RC,0338-0089-04,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 500 Ml In 1 Bag (0338-0117-03),250,RC,0338-0117-03,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag,250,RC,0338-0049-11,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),250,RC,0338-0049-04,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 4 Bag In 1 Pouch (0338-0017-18)  / 100 Ml In 1 Bag,250,RC,0338-0017-18,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 16 Bag In 1 Pouch (0338-0017-31)  / 50 Ml In 1 Bag,250,RC,0338-0017-31,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 250 Ml In 1 Bag (0338-0023-02),250,RC,0338-0023-02,NDC,,,facility,both,1,EA,,3.11,3.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1870-10,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 1000 Ml In 1 Bag (0338-0023-04),250,RC,0338-0023-04,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04),250,RC,0338-0043-04,NDC,,,facility,both,1,EA,,6.86,6.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04),250,RC,0338-0043-04,NDC,,,facility,both,1,EA,,7.64,7.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04),250,RC,0338-0043-04,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03)  / 500 Ml In 1 Bottle, Plastic",250,RC,0338-0048-03,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),250,RC,0338-0049-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),250,RC,0338-0049-02,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03),250,RC,0338-0049-03,NDC,,,facility,both,1,EA,,3.83,3.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),250,RC,0338-0117-04,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0803-04),250,RC,0338-0803-04,NDC,,,facility,both,1,EA,,8.59,8.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitroglycerin In Dextrose: 12 Bottle, Glass In 1 Box (0338-1051-02)  / 250 Ml In 1 Bottle, Glass",250,RC,0338-1051-02,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag,250,RC,0338-1055-48,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag,250,RC,0338-1075-02,NDC,,,facility,both,1,EA,,16.83,16.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 40 Bag In 1 Case (0338-1709-40)  / 100 Ml In 1 Bag,250,RC,0338-1709-40,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0338-3612-50,NDC,,,facility,both,1,EA,,4.67,4.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0338-3814-50,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Bag In 1 Carton (0338-6045-37)  / 200 Ml In 1 Bag,250,RC,0338-6045-37,NDC,,,facility,both,1,EA,,8.73,8.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),250,RC,0338-9159-30,NDC,,,facility,both,1,EA,,5.51,5.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48)  / 100 Ml In 1 Bag,250,RC,0338-0709-48,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Bag In 1 Carton (0338-0705-48)  / 100 Ml In 1 Bag,250,RC,0338-0705-48,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0125-04),250,RC,0338-0125-04,NDC,,,facility,both,1,EA,,3.67,3.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Myxredlin: 12 Container In 1 Carton (0338-0126-12)  / 100 Ml In 1 Container,250,RC,0338-0126-12,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Plasma-Lyte A: 1000 Ml In 1 Bag (0338-0221-04),250,RC,0338-0221-04,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Recothrom: 1 Kit In 1 Kit (0338-0322-01)  *  5 Ml In 1 Vial (0338-0324-01)  *  5 Ml In 1 Syringe,250,RC,0338-0322-01,NDC,,,facility,both,1,EA,,134.01,134.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0338-0324-01,NDC,,,facility,both,1,EA,,121.8,121.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Osmitrol: 500 Ml In 1 Bag (0338-0357-03),250,RC,0338-0357-03,NDC,,,facility,both,1,EA,,53.8,53.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Osmitrol: 500 Ml In 1 Bag (0338-0357-03),250,RC,0338-0357-03,NDC,,,facility,both,1,EA,,9.18,9.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag,250,RC,0338-0411-02,NDC,,,facility,both,1,EA,,13.58,13.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag,250,RC,0338-0411-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18),250,RC,0338-0553-18,NDC,,,facility,both,1,EA,,5.04,5.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0669-04),250,RC,0338-0669-04,NDC,,,facility,both,1,EA,,7.35,7.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0671-04),250,RC,0338-0671-04,NDC,,,facility,both,1,EA,,7.38,7.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0675-04),250,RC,0338-0675-04,NDC,,,facility,both,1,EA,,17.64,17.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose: 1000 Ml In 1 Bag (0338-0683-04),250,RC,0338-0683-04,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0691-04)  / 1000 Ml In 1 Bag,250,RC,0338-0691-04,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0704-34)  / 1000 Ml In 1 Bag,250,RC,0338-0704-34,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01),250,RC,0406-3243-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01),250,RC,0406-3243-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ketamine Hydrochloride: 10 Vial, Multi-Dose In 1 Box (0409-2051-05)  / 5 Ml In 1 Vial, Multi-Dose (0409-2051-15)",250,RC,0409-2051-05,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2051-15,NDC,,,facility,both,1,EA,,10.82,10.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2305-16,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",250,RC,0409-2305-17,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",250,RC,0409-2305-17,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2308-22,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2339-24,NDC,,,facility,both,1,EA,,5.1,5.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dobutamine: 10 Vial, Single-Dose In 1 Tray (0409-2344-02)  / 20 Ml In 1 Vial, Single-Dose (0409-2344-62)",250,RC,0409-2344-02,NDC,,,facility,both,1,EA,,9.56,9.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2347-31,NDC,,,facility,both,1,EA,,10.29,10.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose",250,RC,0409-2634-50,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2720-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2720-30)",250,RC,0409-2720-01,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2050-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1746-71,NDC,,,facility,both,1,EA,,6.55,6.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1778-15,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1778-15,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1886-22,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 10 Cartridge In 1 Carton (0409-1890-01)  / 1 Ml In 1 Cartridge (0409-1890-03),250,RC,0409-1890-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1890-03,NDC,,,facility,both,1,EA,,5.45,5.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 10 Cartridge In 1 Carton (0409-1891-01)  / 1 Ml In 1 Cartridge (0409-1891-03),250,RC,0409-1891-01,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adenosine: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1932-02)  / 30 mL in 1 VIAL, SINGLE-DOSE",250,RC,0409-1932-02,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1985-03,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Tray (0409-2720-03)  / 30 Ml In 1 Vial, Multi-Dose (0409-2720-32)",250,RC,0409-2720-03,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3414-21,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3724-11,NDC,,,facility,both,1,EA,,6.49,6.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3793-19,NDC,,,facility,both,1,EA,,4.75,4.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3795-19,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3815-11,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3815-12)  / 10 Ml In 1 Vial, Glass (0409-3815-11)",250,RC,0409-3815-12,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4031-16,NDC,,,facility,both,1,EA,,3.33,3.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4264-11,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4264-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-4276-16)",250,RC,0409-4276-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-4276-16,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-4277-16)",250,RC,0409-4277-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3414-18,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2720-30,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2723-30,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-2723-30,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3178-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-3178-16)",250,RC,0409-3178-01,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3178-16,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3178-17,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3178-18,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride And Epinephrine: 5 Vial, Single-Dose In 1 Carton (0409-3181-01)  / 30 Ml In 1 Vial, Single-Dose (0409-3181-11)",250,RC,0409-3181-01,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3182-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-3182-11)",250,RC,0409-3182-01,NDC,,,facility,both,1,EA,,4.49,4.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3183-11,NDC,,,facility,both,1,EA,,3.57,3.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetylcysteine: 3 Vial In 1 Carton (0409-3308-03)  / 30 Ml In 1 Vial (0409-3308-11),250,RC,0409-3308-03,NDC,,,facility,both,1,EA,,13.41,13.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3308-11,NDC,,,facility,both,1,EA,,13.41,13.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3375-14,NDC,,,facility,both,1,EA,,10.3,10.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 25 Vial, Single-Dose In 1 Tray (0409-3414-01)  / 2 Ml In 1 Vial, Single-Dose (0409-3414-18)",250,RC,0409-3414-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 25 Vial, Single-Dose In 1 Tray (0409-3414-11)  / 2 Ml In 1 Vial, Single-Dose (0409-3414-21)",250,RC,0409-3414-11,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-3300-01,NDC,,,facility,both,1,EA,,4.32,4.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1746-70,NDC,,,facility,both,1,EA,,22.51,22.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-30)  / 30 Ml In 1 Vial, Single-Dose (0409-1746-71)",250,RC,0409-1746-30,NDC,,,facility,both,1,EA,,19.19,19.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-0125-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbocaine: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1041-30)  / 30 mL in 1 VIAL, SINGLE-DOSE",250,RC,0409-1041-30,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1141-12,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",250,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",250,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",250,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",250,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-1160-01)  / 50 Ml In 1 Vial, Multi-Dose (0409-1160-18)",250,RC,0409-1160-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride And Epinephrine: 10 Vial, Multi-Dose In 1 Carton (0409-0007-10)  / 20 Ml In 1 Vial, Multi-Dose (0409-0007-01)",250,RC,0409-0007-10,NDC,,,facility,both,1,EA,,2.16,2.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-0007-01,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Carton (0409-0001-25)  / 2 Ml In 1 Vial, Single-Dose (0409-0001-01)",250,RC,0409-0001-25,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01),250,RC,0406-3244-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01),250,RC,0406-3244-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23),250,RC,0406-5771-23,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23),250,RC,0406-5771-23,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)",250,RC,0406-8315-23,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)",250,RC,0406-8315-23,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)",250,RC,0406-8330-23,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)",250,RC,0406-8330-23,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8390-23)",250,RC,0406-8390-23,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8510-23),250,RC,0406-8510-23,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8510-23),250,RC,0406-8510-23,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8515-23),250,RC,0406-8515-23,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8515-23),250,RC,0406-8515-23,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mixed Salts Of A Single Entity Amphetamine Product Xr: 100 Capsule, Extended Release In 1 Bottle (0406-8951-01)",250,RC,0406-8951-01,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9112-76)  / 1 Patch In 1 Pouch / 72 H In 1 Patch,250,RC,0406-9112-76,NDC,,,facility,both,1,EA,,29.36,29.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Temazepam: 100 Capsule In 1 Bottle (0406-9961-01),250,RC,0406-9961-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Temazepam: 100 Capsule In 1 Bottle (0406-9961-01),250,RC,0406-9961-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-0001-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1162-18)",250,RC,0409-1162-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1283-17,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03),250,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03),250,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0409-1319-01)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",250,RC,0409-1319-01,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-1323-05)  / 1 Syringe, Plastic In 1 Carton / 5 Ml In 1 Syringe, Plastic (0409-1323-15)",250,RC,0409-1323-05,NDC,,,facility,both,1,EA,,8.74,8.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-1323-05)  / 1 Syringe, Plastic In 1 Carton / 5 Ml In 1 Syringe, Plastic (0409-1323-15)",250,RC,0409-1323-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1463-71,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1555-64,NDC,,,facility,both,1,EA,,162.68,162.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Marcaine: 1 Vial, Multi-Dose In 1 Carton (0409-1610-50)  / 50 Ml In 1 Vial, Multi-Dose",250,RC,0409-1610-50,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1626-21,NDC,,,facility,both,1,EA,,8.78,8.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-30)  / 30 Ml In 1 Vial, Single-Dose (0409-1746-71)",250,RC,0409-1746-30,NDC,,,facility,both,1,EA,,8.36,8.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1283-17,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)",250,RC,0409-1162-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)",250,RC,0409-1165-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)",250,RC,0409-1165-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1165-18,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride And Epinephrine: 10 Ampule In 1 Tray (0409-1209-01)  / 5 Ml In 1 Ampule (0409-1209-10),250,RC,0409-1209-01,NDC,,,facility,both,1,EA,,4.45,4.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1209-10,NDC,,,facility,both,1,EA,,4.91,4.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1215-21,NDC,,,facility,both,1,EA,,27.76,27.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1273-03,NDC,,,facility,both,1,EA,,19.9,19.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diazepam: 10 Cartridge In 1 Carton (0409-1273-32)  / 2 Ml In 1 Cartridge (0409-1273-03),250,RC,0409-1273-32,NDC,,,facility,both,1,EA,,21.51,21.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0409-1207-13,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 4 Bag In 1 Pouch (0338-0017-11)  / 50 Ml In 1 Bag,250,RC,0338-0017-11,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 500 Ml In 1 Bag (0338-0023-03),250,RC,0338-0023-03,NDC,,,facility,both,1,EA,,6.55,6.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 1000 Ml In 1 Bag (0338-0017-04),250,RC,0338-0017-04,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9746-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9785-01,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9785-01,NDC,,,facility,both,1,EA,,4.26,4.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9785-01,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproate Sodium: 10 Vial, Single-Dose In 1 Carton (0143-9785-10)  / 5 Ml In 1 Vial, Single-Dose (0143-9785-01)",250,RC,0143-9785-10,NDC,,,facility,both,1,EA,,3.66,3.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9786-01,NDC,,,facility,both,1,EA,,7.56,7.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9856-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 25 Vial In 1 Box (0143-9875-25)  / 3 Ml In 1 Vial (0143-9875-01),250,RC,0143-9875-25,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Ml In 1 Bottle (0143-9889-01),250,RC,0143-9889-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 3 Ml In 1 Vial (0143-9924-90),250,RC,0143-9924-90,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0003-15)  / 15 G In 1 Tube,250,RC,0168-0003-15,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0003-15)  / 15 G In 1 Tube,250,RC,0168-0003-15,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0004-15)  / 15 G In 1 Tube,250,RC,0168-0004-15,NDC,,,facility,both,1,EA,,4.77,4.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0004-15)  / 15 G In 1 Tube,250,RC,0168-0004-15,NDC,,,facility,both,1,EA,,4.73,4.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9633-01,NDC,,,facility,both,1,EA,,88.67,88.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Testosterone Cypionate: 1 Ml In 1 Vial (0143-9659-01),250,RC,0143-9659-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoprolol Tartrate: 10 Vial In 1 Carton (0143-9660-10)  / 5 Ml In 1 Vial (0143-9660-01),250,RC,0143-9660-10,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9673-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9682-25)  / 1 Ml In 1 Vial (0143-9682-01),250,RC,0143-9682-25,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9689-01,NDC,,,facility,both,1,EA,,9.65,9.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 15 G In 1 Tube (0168-0006-15),250,RC,0168-0006-15,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diazepam: 100 Tablet In 1 Bottle (0172-3925-60),250,RC,0172-3925-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diazepam: 100 Tablet In 1 Bottle (0172-3925-60),250,RC,0172-3925-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0517-00)",250,RC,0173-0517-00,NDC,,,facility,both,1,EA,,27.2,27.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0519-00)",250,RC,0173-0519-00,NDC,,,facility,both,1,EA,,35.74,35.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ventolin Hfa: 1 Inhaler In 1 Carton (0173-0682-24)  / 60 Aerosol, Metered In 1 Inhaler",250,RC,0173-0682-24,NDC,,,facility,both,1,EA,,40.59,40.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ventolin Hfa: 1 Inhaler In 1 Carton (0173-0682-24)  / 60 Aerosol, Metered In 1 Inhaler",250,RC,0173-0682-24,NDC,,,facility,both,1,EA,,40.53,40.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Breo Ellipta: 1 Tray In 1 Carton (0173-0859-14)  / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler,250,RC,0173-0859-14,NDC,,,facility,both,1,EA,,114.81,114.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Breo Ellipta: 1 Tray In 1 Carton (0173-0859-14)  / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler,250,RC,0173-0859-14,NDC,,,facility,both,1,EA,,114.95,114.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Anoro Ellipta: 1 Tray In 1 Carton (0173-0869-06)  / 1 Inhaler In 1 Tray / 7 Powder In 1 Inhaler,250,RC,0173-0869-06,NDC,,,facility,both,1,EA,,138.63,138.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Anoro Ellipta: 1 Tray In 1 Carton (0173-0869-06)  / 1 Inhaler In 1 Tray / 7 Powder In 1 Inhaler,250,RC,0173-0869-06,NDC,,,facility,both,1,EA,,138.7,138.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Anoro Ellipta: 1 Tray In 1 Carton (0173-0869-10)  / 1 Inhaler In 1 Tray / 30 Powder In 1 Inhaler,250,RC,0173-0869-10,NDC,,,facility,both,1,EA,,578.83,578.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Anoro Ellipta: 1 Tray In 1 Carton (0173-0869-10)  / 1 Inhaler In 1 Tray / 30 Powder In 1 Inhaler,250,RC,0173-0869-10,NDC,,,facility,both,1,EA,,578.83,578.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0874-10)  / 30 Powder In 1 Inhaler,250,RC,0173-0874-10,NDC,,,facility,both,1,EA,,365.2,365.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0874-14)  / 14 Powder In 1 Inhaler,250,RC,0173-0874-14,NDC,,,facility,both,1,EA,,125.13,125.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0874-14)  / 14 Powder In 1 Inhaler,250,RC,0173-0874-14,NDC,,,facility,both,1,EA,,125.16,125.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0876-14)  / 14 Powder In 1 Inhaler,250,RC,0173-0876-14,NDC,,,facility,both,1,EA,,168.1,168.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Breo Ellipta: 1 Tray In 1 Carton (0173-0882-14)  / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler,250,RC,0173-0882-14,NDC,,,facility,both,1,EA,,115.07,115.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Breo Ellipta: 1 Tray In 1 Carton (0173-0882-14)  / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler,250,RC,0173-0882-14,NDC,,,facility,both,1,EA,,114.94,114.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (0185-0122-01),250,RC,0185-0122-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (0185-0122-01),250,RC,0185-0122-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60),250,RC,0172-2089-60,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 15 G In 1 Tube (0168-0006-15),250,RC,0168-0006-15,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60),250,RC,0172-2089-60,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass",250,RC,0169-7501-11,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 80 G In 1 Tube (0168-0006-80),250,RC,0168-0006-80,NDC,,,facility,both,1,EA,,12.24,12.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 80 G In 1 Tube (0168-0006-80),250,RC,0168-0006-80,NDC,,,facility,both,1,EA,,12.24,12.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bacitracin Zinc: 453.6 g in 1 JAR (0168-0011-16) ,250,RC,0168-0011-16,NDC,,,facility,both,1,EA,,68.35,68.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Betamethasone Valerate: 45 G In 1 Tube (0168-0033-46),250,RC,0168-0033-46,NDC,,,facility,both,1,EA,,34.49,34.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketoconazole: 1 Tube In 1 Carton (0168-0099-15)  / 15 G In 1 Tube,250,RC,0168-0099-15,NDC,,,facility,both,1,EA,,21.67,21.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 29 G In 1 Tube (0168-0146-30),250,RC,0168-0146-30,NDC,,,facility,both,1,EA,,4.67,4.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Phosphate: 1 Bottle In 1 Carton (0168-0201-60)  / 60 Ml In 1 Bottle,250,RC,0168-0201-60,NDC,,,facility,both,1,EA,,60.57,60.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine And Prilocaine: 1 Tube In 1 Carton (0168-0357-30)  / 30 G In 1 Tube,250,RC,0168-0357-30,NDC,,,facility,both,1,EA,,25.41,25.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine And Prilocaine: 1 Tube In 1 Carton (0168-0357-30)  / 30 G In 1 Tube,250,RC,0168-0357-30,NDC,,,facility,both,1,EA,,25.41,25.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine And Prilocaine: 1 Tube In 1 Carton (0168-0357-55)  / 5 G In 1 Tube (0168-0357-05),250,RC,0168-0357-55,NDC,,,facility,both,1,EA,,13.87,13.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial,250,RC,0169-1833-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin N: 1 Vial In 1 Carton (0169-1834-11)  / 10 Ml In 1 Vial,250,RC,0169-1834-11,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin N: 1 Vial In 1 Carton (0169-1834-11)  / 10 Ml In 1 Vial,250,RC,0169-1834-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin 70/30: 1 Vial In 1 Carton (0169-1837-11)  / 10 Ml In 1 Vial,250,RC,0169-1837-11,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tresiba: 1 Vial, Glass In 1 Carton (0169-2662-11)  / 10 Ml In 1 Vial, Glass",250,RC,0169-2662-11,NDC,,,facility,both,1,EA,,11.67,11.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tresiba: 1 Vial, Glass In 1 Carton (0169-2662-11)  / 10 Ml In 1 Vial, Glass",250,RC,0169-2662-11,NDC,,,facility,both,1,EA,,10.81,10.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass",250,RC,0169-7501-11,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass",250,RC,0169-7501-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (0143-9595-25)  / 5 Ml In 1 Vial, Single-Dose (0143-9595-01)",250,RC,0143-9595-25,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9595-01,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9594-01,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2480-60)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2480-60,NDC,,,facility,both,1,EA,,39.76,39.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"465 mL in 1 BOTTLE, PLASTIC (0131-5410-70) ",250,RC,0131-5410-70,NDC,,,facility,both,1,EA,,42.32,42.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 200 Ml In 1 Bottle, Glass (0131-5410-72)",250,RC,0131-5410-72,NDC,,,facility,both,1,EA,,84.68,84.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fleet: 12 SUPPOSITORY in 1 JAR (0132-0079-12) ,250,RC,0132-0079-12,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pedia-Lax: 12 Suppository In 1 Jar (0132-0081-12),250,RC,0132-0081-12,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)",250,RC,0132-0201-40,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)",250,RC,0132-0201-40,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pedia-Lax: 66 Ml In 1 Bottle, With Applicator (0132-0202-20)",250,RC,0132-0202-20,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Tablet In 1 Bottle (0143-1171-01),250,RC,0143-1171-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Tablet In 1 Bottle (0143-1171-01),250,RC,0143-1171-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxycycline Hyclate: 500 Tablet, Coated In 1 Bottle (0143-2112-05)",250,RC,0143-2112-05,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxycycline Hyclate: 50 Capsule, Gelatin Coated In 1 Bottle, Plastic (0143-3142-50)",250,RC,0143-3142-50,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxycycline Hyclate: 50 Capsule, Gelatin Coated In 1 Bottle, Plastic (0143-3142-50)",250,RC,0143-3142-50,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9139-01,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9139-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9156-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2479-60)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2479-60,NDC,,,facility,both,1,EA,,39.72,39.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2478-60)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2478-60,NDC,,,facility,both,1,EA,,36.61,36.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1882-11,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-1882-11,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4675-05,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4721-05,NDC,,,facility,both,1,EA,,6.86,6.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4759-05,NDC,,,facility,both,1,EA,,3.09,3.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 4 TRAY in 1 CASE (0121-4785-05)  / 10 CUP, UNIT-DOSE in 1 TRAY / 5 mL in 1 CUP, UNIT-DOSE",250,RC,0121-4785-05,NDC,,,facility,both,1,EA,,8.89,8.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 4 TRAY in 1 CASE (0121-4785-05)  / 10 CUP, UNIT-DOSE in 1 TRAY / 5 mL in 1 CUP, UNIT-DOSE",250,RC,0121-4785-05,NDC,,,facility,both,1,EA,,8,8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4799-05,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4799-05,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4827-05,NDC,,,facility,both,1,EA,,4.95,4.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4827-05,NDC,,,facility,both,1,EA,,9.57,9.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4950-15,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4950-15,NDC,,,facility,both,1,EA,,6.99,6.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4967-05,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0121-4967-05,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2477-60)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2477-60,NDC,,,facility,both,1,EA,,23.76,23.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2477-60)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2477-60,NDC,,,facility,both,1,EA,,23.89,23.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2479-60)  / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2479-60,NDC,,,facility,both,1,EA,,39.75,39.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9156-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9382-01,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9383-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01)  / 5 Ml In 1 Vial, Single-Dose",250,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 1 Vial In 1 Box, Unit-Dose (0143-9503-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,0143-9503-01,NDC,,,facility,both,1,EA,,22.14,22.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9506-01,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9508-01,NDC,,,facility,both,1,EA,,10.54,10.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9509-01,NDC,,,facility,both,1,EA,,11.3,11.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketamine Hydrochloride: 10 Vial In 1 Box (0143-9509-10)  / 5 Ml In 1 Vial (0143-9509-01),250,RC,0143-9509-10,NDC,,,facility,both,1,EA,,11.34,11.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9525-01,NDC,,,facility,both,1,EA,,32.54,32.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9532-01,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01)  / 1 Ml In 1 Vial,250,RC,0143-9564-01,NDC,,,facility,both,1,EA,,841.26,841.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9594-01,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9338-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9335-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9161-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9162-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01)  / 10.25 G In 1 Vial, Pharmacy Bulk Package",250,RC,0143-9164-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9184-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9210-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9273-01,NDC,,,facility,both,1,EA,,110.78,110.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9284-01,NDC,,,facility,both,1,EA,,4.63,4.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9318-01,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Norepinephrine Bitartrate: 10 Vial In 1 Carton (0143-9318-10)  / 4 Ml In 1 Vial (0143-9318-01),250,RC,0143-9318-10,NDC,,,facility,both,1,EA,,5.37,5.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9332-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9334-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9334-01)",250,RC,0143-9334-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0143-9250-01,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methimazole: 100 TABLET in 1 BOTTLE (0185-0210-01) ,250,RC,0185-0210-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0876-14)  / 14 Powder In 1 Inhaler,250,RC,0173-0876-14,NDC,,,facility,both,1,EA,,167.68,167.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0674-01),250,RC,0185-0674-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7612-10)  / 500 Ml In 1 Container,250,RC,0264-7612-10,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7622-00)  / 1000 Ml In 1 Container,250,RC,0264-7622-00,NDC,,,facility,both,1,EA,,15.39,15.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7623-20)  / 250 Ml In 1 Container,250,RC,0264-7623-20,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7634-00)  / 1000 Ml In 1 Container,250,RC,0264-7634-00,NDC,,,facility,both,1,EA,,13.51,13.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7635-00)  / 1000 Ml In 1 Container,250,RC,0264-7635-00,NDC,,,facility,both,1,EA,,5.91,5.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7638-00)  / 1000 Ml In 1 Container,250,RC,0264-7638-00,NDC,,,facility,both,1,EA,,11.74,11.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7652-00)  / 1000 Ml In 1 Container,250,RC,0264-7652-00,NDC,,,facility,both,1,EA,,7.91,7.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isolyte S Ph 7.4: 12 Container In 1 Case (0264-7707-00)  / 1000 Ml In 1 Container,250,RC,0264-7707-00,NDC,,,facility,both,1,EA,,8.23,8.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isolyte S Ph 7.4: 24 Container In 1 Case (0264-7707-10)  / 500 Ml In 1 Container,250,RC,0264-7707-10,NDC,,,facility,both,1,EA,,8.21,8.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Container In 1 Case (0264-7750-00)  / 1000 Ml In 1 Container,250,RC,0264-7750-00,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Container In 1 Case (0264-7750-07)  / 1000 Ml In 1 Container,250,RC,0264-7750-07,NDC,,,facility,both,1,EA,,3.53,3.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Container In 1 Case (0264-7750-07)  / 1000 Ml In 1 Container,250,RC,0264-7750-07,NDC,,,facility,both,1,EA,,3.44,3.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 Container In 1 Case (0264-7750-10)  / 500 Ml In 1 Container,250,RC,0264-7750-10,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00)  / 1000 Ml In 1 Container,250,RC,0264-7751-00,NDC,,,facility,both,1,EA,,5.85,5.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-7800-00)  / 1000 Ml In 1 Container,250,RC,0264-7800-00,NDC,,,facility,both,1,EA,,5.88,5.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-7800-09)  / 1000 Ml In 1 Container,250,RC,0264-7800-09,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00)  / 1000 Ml In 1 Container,250,RC,0264-7612-00,NDC,,,facility,both,1,EA,,5.84,5.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00)  / 1000 Ml In 1 Container,250,RC,0264-7610-00,NDC,,,facility,both,1,EA,,2.93,2.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 6 Carton In 1 Case (0264-5535-32)  / 4 Container In 1 Carton / 100 Ml In 1 Container,250,RC,0264-5535-32,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-5802-00)  / 1000 Ml In 1 Container,250,RC,0264-5802-00,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-5802-00)  / 1000 Ml In 1 Container,250,RC,0264-5802-00,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container,250,RC,0264-5802-10,NDC,,,facility,both,1,EA,,3.85,3.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-5804-00)  / 1000 Ml In 1 Container,250,RC,0264-5804-00,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-50)  / 2000 Ml In 1 Container,250,RC,0264-7388-50,NDC,,,facility,both,1,EA,,19.11,19.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Container In 1 Case (0264-7510-00)  / 1000 Ml In 1 Container,250,RC,0264-7510-00,NDC,,,facility,both,1,EA,,5.89,5.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7510-10)  / 500 Ml In 1 Container,250,RC,0264-7510-10,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7510-20)  / 250 Ml In 1 Container,250,RC,0264-7510-20,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Container In 1 Case (0264-7520-00)  / 1000 Ml In 1 Container,250,RC,0264-7520-00,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7520-10)  / 500 Ml In 1 Container,250,RC,0264-7520-10,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7520-20)  / 250 Ml In 1 Container,250,RC,0264-7520-20,NDC,,,facility,both,1,EA,,4.42,4.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7800-10)  / 500 Ml In 1 Container,250,RC,0264-7800-10,NDC,,,facility,both,1,EA,,5.12,5.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6205-30)",250,RC,0310-6205-30,NDC,,,facility,both,1,EA,,24.52,24.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6205-30)",250,RC,0310-6205-30,NDC,,,facility,both,1,EA,,24.51,24.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6210-30)",250,RC,0310-6210-30,NDC,,,facility,both,1,EA,,24.26,24.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide And Formoterol Fumarate Dihydrate: 1 Pouch In 1 Carton (0310-7372-20)  / 1 Canister In 1 Pouch / 120 Aerosol In 1 Canister,250,RC,0310-7372-20,NDC,,,facility,both,1,EA,,316.24,316.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sarna: 222 Ml In 1 Bottle, Pump (0316-0229-75)",250,RC,0316-0229-75,NDC,,,facility,both,1,EA,,11.39,11.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clorpactin Wcs-90: 5 Vial In 1 Box (0327-0001-10)  / 2 G In 1 Vial,250,RC,0327-0001-10,NDC,,,facility,both,1,EA,,11.26,11.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clorpactin Wcs-90: 5 Vial In 1 Box (0327-0001-10)  / 2 G In 1 Vial,250,RC,0327-0001-10,NDC,,,facility,both,1,EA,,11.03,11.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 18 Bottle, Plastic In 1 Carton (0338-0004-03)  / 500 Ml In 1 Bottle, Plastic",250,RC,0338-0004-03,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 18 Bottle, Plastic In 1 Carton (0338-0004-03)  / 500 Ml In 1 Bottle, Plastic",250,RC,0338-0004-03,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 12 Bottle, Plastic In 1 Carton (0338-0004-04)  / 1000 Ml In 1 Bottle, Plastic",250,RC,0338-0004-04,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sterile Water: 12 Bottle, Plastic In 1 Carton (0338-0004-04)  / 1000 Ml In 1 Bottle, Plastic",250,RC,0338-0004-04,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 250 Ml In 1 Bag (0338-0017-02),250,RC,0338-0017-02,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 500 Ml In 1 Bag (0338-0017-03),250,RC,0338-0017-03,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0310-1110-01,NDC,,,facility,both,1,EA,,15.74,15.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container,250,RC,0264-7800-20,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-7802-00)  / 1000 Ml In 1 Container,250,RC,0264-7802-00,NDC,,,facility,both,1,EA,,5.79,5.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7802-10)  / 500 Ml In 1 Container,250,RC,0264-7802-10,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7805-10)  / 500 Ml In 1 Container,250,RC,0264-7805-10,NDC,,,facility,both,1,EA,,6.06,6.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 12 Container In 1 Case (0264-7850-00)  / 1000 Ml In 1 Container,250,RC,0264-7850-00,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 24 Container In 1 Case (0264-7850-10)  / 500 Ml In 1 Container,250,RC,0264-7850-10,NDC,,,facility,both,1,EA,,4.82,4.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 12 Container In 1 Case (0264-7865-00)  / 1000 Ml In 1 Container,250,RC,0264-7865-00,NDC,,,facility,both,1,EA,,3.53,3.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20)  / 250 Ml In 1 Container,250,RC,0264-9587-20,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Kinevac: 10 Vial In 1 Package (0270-0556-15)  / 5 Ml In 1 Vial,250,RC,0270-0556-15,NDC,,,facility,both,1,EA,,58.02,58.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitro-Bid: 48 Packet In 1 Box (0281-0326-08)  / 1 G In 1 Packet,250,RC,0281-0326-08,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hurricaine Topical Anesthetic: 59.7 G In 1 Can (0283-0679-02),250,RC,0283-0679-02,NDC,,,facility,both,1,EA,,57.85,57.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"100 BLISTER PACK in 1 CARTON (0310-0275-39)  / 1 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,0310-0275-39,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"100 BLISTER PACK in 1 CARTON (0310-0275-39)  / 1 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,0310-0275-39,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0310-1105-01,NDC,,,facility,both,1,EA,,15.72,15.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0310-1105-01,NDC,,,facility,both,1,EA,,15.51,15.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0310-1110-01,NDC,,,facility,both,1,EA,,15.53,15.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Container In 1 Case (0264-4400-54)  / 100 Ml In 1 Container,250,RC,0264-4400-54,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container,250,RC,0264-5802-10,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 24 Container In 1 Case (0264-4100-90)  / 100 Ml In 1 Container,250,RC,0264-4100-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2128-10),250,RC,0228-2128-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2128-10),250,RC,0228-2128-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 60 Capsule, Delayed Release Pellets In 1 Bottle (0228-2890-06)",250,RC,0228-2890-06,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 60 Capsule, Delayed Release Pellets In 1 Bottle (0228-2890-06)",250,RC,0228-2890-06,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)",250,RC,0228-2891-03,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)",250,RC,0228-2891-03,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)",250,RC,0228-2892-03,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)",250,RC,0228-2892-03,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prevalite: 42 Packet In 1 Carton (0245-0036-42)  / 5.5 G In 1 Packet (0245-0036-89),250,RC,0245-0036-42,NDC,,,facility,both,1,EA,,3.6,3.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pacerone: 30 Tablet In 1 Bottle (0245-0144-30),250,RC,0245-0144-30,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pacerone: 30 Tablet In 1 Bottle (0245-0144-30),250,RC,0245-0144-30,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0144-89,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0144-89,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pacerone: 100 Blister Pack In 1 Carton (0245-0147-01)  / 1 Tablet In 1 Blister Pack (0245-0147-89),250,RC,0245-0147-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0147-89,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0147-89,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0211-11),250,RC,0245-0211-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0211-11),250,RC,0245-0211-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10),250,RC,0228-2127-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 TABLET in 1 BOTTLE (0228-2057-10) ,250,RC,0228-2057-10,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0674-01),250,RC,0185-0674-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 500 Capsule In 1 Bottle (0185-0674-05),250,RC,0185-0674-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0676-01),250,RC,0185-0676-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfadiazine: 100 TABLET in 1 BOTTLE (0185-0757-01) ,250,RC,0185-0757-01,NDC,,,facility,both,1,EA,,6.4,6.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0185-0842-01)",250,RC,0185-0842-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0185-0842-01)",250,RC,0185-0842-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Symbicort: 1 Pouch In 1 Carton (0186-0370-28)  / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister,250,RC,0186-0370-28,NDC,,,facility,both,1,EA,,110.27,110.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Symbicort: 1 Pouch In 1 Carton (0186-0370-28)  / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister,250,RC,0186-0370-28,NDC,,,facility,both,1,EA,,109.97,109.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Symbicort: 1 Pouch In 1 Carton (0186-0372-28)  / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister,250,RC,0186-0372-28,NDC,,,facility,both,1,EA,,109.93,109.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39)  / 10 Tablet In 1 Blister Pack",250,RC,0186-0777-39,NDC,,,facility,both,1,EA,,13.81,13.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39)  / 10 Tablet In 1 Blister Pack",250,RC,0186-0777-39,NDC,,,facility,both,1,EA,,13.84,13.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mestinon: 473 Ml In 1 Bottle (0187-3012-20),250,RC,0187-3012-20,NDC,,,facility,both,1,EA,,31.36,31.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0223-1760-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0223-1760-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neo-Synephrine Mild: 15 Ml In 1 Bottle, Spray (0225-0800-47)",250,RC,0225-0800-47,NDC,,,facility,both,1,EA,,6.8,6.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0228-2031-10),250,RC,0228-2031-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0228-2031-10),250,RC,0228-2031-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10),250,RC,0228-2127-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0212-11),250,RC,0245-0212-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pacerone: 100 Blister Pack In 1 Carton (0245-0147-01)  / 1 Tablet In 1 Blister Pack (0245-0147-89),250,RC,0245-0147-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0212-89,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 64 Container In 1 Case (0264-1510-32)  / 100 Ml In 1 Container,250,RC,0264-1510-32,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 64 Container In 1 Case (0264-1510-32)  / 100 Ml In 1 Container,250,RC,0264-1510-32,NDC,,,facility,both,1,EA,,3.46,3.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container,250,RC,0264-1800-31,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0212-11),250,RC,0245-0212-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container,250,RC,0264-1800-32,NDC,,,facility,both,1,EA,,3.53,3.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container,250,RC,0264-1800-32,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container,250,RC,0264-1800-32,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trophamine: 12 Container In 1 Case (0264-1933-10)  / 500 Ml In 1 Container,250,RC,0264-1933-10,NDC,,,facility,both,1,EA,,6.63,6.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 16 Container In 1 Case (0264-2101-00)  / 1000 Ml In 1 Container,250,RC,0264-2101-00,NDC,,,facility,both,1,EA,,5.16,5.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 16 Container In 1 Case (0264-2101-00)  / 1000 Ml In 1 Container,250,RC,0264-2101-00,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sterile Water: 16 Container In 1 Case (0264-2101-10)  / 500 Ml In 1 Container,250,RC,0264-2101-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Container In 1 Case (0264-2201-00)  / 1000 Ml In 1 Container,250,RC,0264-2201-00,NDC,,,facility,both,1,EA,,5.88,5.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Container In 1 Case (0264-2201-10)  / 500 Ml In 1 Container,250,RC,0264-2201-10,NDC,,,facility,both,1,EA,,4.75,4.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Container In 1 Case (0264-2201-10)  / 500 Ml In 1 Container,250,RC,0264-2201-10,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
8 CONTAINER in 1 CASE (0264-2201-50)  / 2000 mL in 1 CONTAINER,250,RC,0264-2201-50,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
8 CONTAINER in 1 CASE (0264-2201-50)  / 2000 mL in 1 CONTAINER,250,RC,0264-2201-50,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetic Acid: 16 Container In 1 Case (0264-2304-10)  / 500 Ml In 1 Container,250,RC,0264-2304-10,NDC,,,facility,both,1,EA,,10.52,10.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container,250,RC,0264-1800-31,NDC,,,facility,both,1,EA,,3.88,3.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cuvposa: 1 Bottle In 1 Carton (0259-0501-16)  / 473 Ml In 1 Bottle,250,RC,0259-0501-16,NDC,,,facility,both,1,EA,,9.55,9.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0212-89,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con: 100 Blister Pack In 1 Blister Pack (0245-5316-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (0245-5316-89)",250,RC,0245-5316-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-5316-89,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con M: 100 Blister Pack In 1 Carton (0245-5319-01)  / 1 Tablet, Extended Release In 1 Blister Pack (0245-5319-89)",250,RC,0245-5319-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con M: 100 Blister Pack In 1 Carton (0245-5319-01)  / 1 Tablet, Extended Release In 1 Blister Pack (0245-5319-89)",250,RC,0245-5319-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con M: 100 Tablet, Extended Release In 1 Bottle (0245-5319-11)",250,RC,0245-5319-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con M: 500 Tablet, Extended Release In 1 Bottle (0245-5319-15)",250,RC,0245-5319-15,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-5316-89,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cuvposa: 1 Bottle In 1 Carton (0259-0501-16)  / 473 Ml In 1 Bottle,250,RC,0259-0501-16,NDC,,,facility,both,1,EA,,9.29,9.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con M: 500 Tablet, Extended Release In 1 Bottle (0245-5319-15)",250,RC,0245-5319-15,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3029-02)",250,RC,0254-3029-02,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3028-02)",250,RC,0254-3028-02,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3028-02)",250,RC,0254-3028-02,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0254-3012-78,NDC,,,facility,both,1,EA,,211.89,211.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-5319-89,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,250,RC,0245-5319-89,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diazoxide: 1 Bottle, Dropper In 1 Carton (0254-1010-19)  / 30 Ml In 1 Bottle, Dropper",250,RC,0254-1010-19,NDC,,,facility,both,1,EA,,11.3,11.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zinc Sulfate: 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-6110-25)  / 10 mL in 1 VIAL, SINGLE-DOSE",258,RC,0517-6110-25,NDC,,,facility,both,1,EA,,160,160,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,258,RC,0517-9305-01,NDC,,,facility,both,1,EA,,149.27,149.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,258,RC,72485-507-01,NDC,,,facility,both,1,EA,,160,160,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carnitor: 5 Vial In 1 Carton (54482-147-01)  / 5 Ml In 1 Vial,258,RC,54482-147-01,NDC,,,facility,both,1,EA,,132.5,132.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose",258,RC,63323-184-10,NDC,,,facility,both,1,EA,,160,160,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"M.V.I. Pediatric: 10 VIAL, SINGLE-DOSE in 1 BOX (61703-421-53)  / 5 mL in 1 VIAL, SINGLE-DOSE (61703-421-63) ",258,RC,61703-421-53,NDC,,,facility,both,1,EA,,197.82,197.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Thiamine: 25 Vial, Multi-Dose In 1 Tray (63323-013-02)  / 2 Ml In 1 Vial, Multi-Dose (63323-013-01)",258,RC,63323-013-02,NDC,,,facility,both,1,EA,,154.38,154.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01)  / 10 Ml In 1 Vial, Multi-Dose",258,RC,0002-8215-01,NDC,,,facility,both,1,EA,,134.8,134.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Fluoride F 18: 1 Vial, Multi-Dose In 1 Can (40028-512-30)  / 30 Ml In 1 Vial, Multi-Dose",343,RC,40028-512-30,NDC,,,facility,both,1,EA,,700,700,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Iodide: 1 CAPSULE in 1 BOX (17156-201-05) ,343,RC,17156-201-05,NDC,,,facility,both,1,EA,,363.68,363.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adreview: 1 Vial, Glass In 1 Container (17156-235-01)  / 5 Ml In 1 Vial, Glass",343,RC,17156-235-01,NDC,,,facility,both,1,EA,,5827.25,5827.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Indium Dtpa In 111: 1.5 Ml In 1 Vial, Glass (17156-251-08)",343,RC,17156-251-08,NDC,,,facility,both,1,EA,,2934,2934,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Kit For The Prepartion Of Technetium Tc99M Sulfur Colloid: 1 Kit In 1 Package (45567-0030-1)  *  3 Ml In 1 Vial *  3 Ml In 1 Vial *  10 Ml In 1 Vial,343,RC,45567-0030-1,NDC,,,facility,both,1,EA,,161.92,161.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kit For The Preparation Of Technetium Tc 99M Medronate: 5 Vial, Multi-Dose In 1 Kit (45567-0040-1)  / 10 Ml In 1 Vial, Multi-Dose",343,RC,45567-0040-1,NDC,,,facility,both,1,EA,,71.71,71.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)",343,RC,49609-101-01,NDC,,,facility,both,1,EA,,178.54,178.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kit For The Preparation Of Lymphoseek (Technetium Tc 99M Tilmanocept): 1 Kit In 1 Carton (65857-450-05)  / 1 Kit In 1 Kit *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial (65857-400-01)  *  1 Injection, Solution In 1 Vial (65857-401-45)",343,RC,65857-450-05,NDC,,,facility,both,1,EA,,1359.4,1359.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Drax Exametazime: 5 Vial In 1 Carton (65174-200-05)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (65174-200-01)",343,RC,65174-200-05,NDC,,,facility,both,1,EA,,3974.88,3974.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Drax Exametazime: 5 Vial In 1 Carton (65174-200-05)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (65174-200-01)",343,RC,65174-200-05,NDC,,,facility,both,1,EA,,3628.28,3628.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Draximage Maa: 30 Injection, Powder, For Solution In 1 Kit (65174-270-30)",343,RC,65174-270-30,NDC,,,facility,both,1,EA,,317.64,317.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Draximage Maa: 30 Injection, Powder, For Solution In 1 Kit (65174-270-30)",343,RC,65174-270-30,NDC,,,facility,both,1,EA,,283.01,283.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,343,RC,65174-288-05,NDC,,,facility,both,1,EA,,252.76,252.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,343,RC,99999-5100-03,NDC,,,facility,both,1,EA,,4011.53,4011.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,343,RC,99999-5100-21,NDC,,,facility,both,1,EA,,416.71,416.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,343,RC,99999-5100-30,NDC,,,facility,both,1,EA,,7.51,7.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,343,RC,99999-5100-38,NDC,,,facility,both,1,EA,,238.16,238.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,343,RC,99999-5100-38,NDC,,,facility,both,1,EA,,220.38,220.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Illuccix: 1 Kit In 1 Carton (74725-100-64)  *  2.5 Ml In 1 Vial, Multi-Dose (74725-102-25)  *  6.4 Ml In 1 Vial, Multi-Dose (74725-103-64)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)",343,RC,74725-100-64,NDC,,,facility,both,1,EA,,9257.8,9257.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Illuccix: 1 Kit In 1 Carton (74725-100-64)  *  2.5 Ml In 1 Vial, Multi-Dose (74725-102-25)  *  6.4 Ml In 1 Vial, Multi-Dose (74725-103-64)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)",343,RC,74725-100-64,NDC,,,facility,both,1,EA,,4920,4920,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ultratag Rbc: 5 Cello Pack In 1 Box (69945-068-20)  / 1 Kit In 1 Cello Pack (69945-068-10)  *  .6 Ml In 1 Syringe, Glass *  1 Ml In 1 Syringe, Glass *  9.5 Mg In 1 Vial, Glass",343,RC,69945-068-20,NDC,,,facility,both,1,EA,,314.96,314.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Technescan Hdp: 5 Vial In 1 Cello Pack (69945-091-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (69945-091-01)",343,RC,69945-091-20,NDC,,,facility,both,1,EA,,238.65,238.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Technetium Tc 99M Sestamibi: 5 Vial In 1 Cello Pack (69945-092-20)  / 10 Ml In 1 Vial,343,RC,69945-092-20,NDC,,,facility,both,1,EA,,56.61,56.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Technescan Pyp: 5 Vial In 1 Cello Pack (69945-094-20)  / 10 Ml In 1 Vial (69945-094-01),343,RC,69945-094-20,NDC,,,facility,both,1,EA,,337.77,337.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,5712.47,5712.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,454.36,454.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,2813.05,2813.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Technescan Mag3: 5 Vial In 1 Cello Pack (69945-096-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",343,RC,69945-096-20,NDC,,,facility,both,1,EA,,676.69,676.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Indium In 111 Chloride: 1 Vial, Glass In 1 Can (69945-132-06)  / .5 Ml In 1 Vial, Glass",343,RC,69945-132-06,NDC,,,facility,both,1,EA,,1213.18,1213.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"OCTREOSCAN: 1 KIT in 1 BOX (0019-9050-40)  *  1 mL in 1 VIAL, GLASS *  1 mL in 1 VIAL, GLASS",343,RC,0019-9050-40,NDC,,,facility,both,1,EA,,5881.95,5881.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amyvid: 1 Vial, Multi-Dose In 1 Can (0002-1200-50)  / 50 Ml In 1 Vial, Multi-Dose",343,RC,0002-1200-50,NDC,,,facility,both,1,EA,,4964.98,4964.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Choletec: 10 Vial In 1 Carton (0270-0083-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",343,RC,0270-0083-20,NDC,,,facility,both,1,EA,,59.1,59.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4277-17)",636,RC,0409-4277-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron Hydrochloride: 25 Vial, Single-Dose In 1 Carton (36000-012-25)  / 2 Ml In 1 Vial, Single-Dose",636,RC,36000-012-25,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoprolol: 10 Vial In 1 Carton (36000-033-10)  / 5 Ml In 1 Vial,636,RC,36000-033-10,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoprolol: 10 Vial In 1 Carton (36000-033-10)  / 5 Ml In 1 Vial,636,RC,36000-033-10,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose",636,RC,36000-282-25,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose",636,RC,36000-282-25,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose",636,RC,36000-283-25,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 1 Bottle In 1 Carton (31722-878-01)  / 100 Capsule In 1 Bottle,636,RC,31722-878-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 1 Bottle In 1 Carton (31722-878-01)  / 100 Capsule In 1 Bottle,636,RC,31722-878-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose",636,RC,36000-283-25,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose",636,RC,36000-283-25,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose",636,RC,36000-283-25,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,41376-0496-86,NDC,,,facility,both,1,EA,,8.93,8.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pitocin: 25 Vial In 1 Carton (42023-116-02)  / 10 Ml In 1 Vial,636,RC,42023-116-02,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pitocin: 25 Vial In 1 Tray (42023-116-25)  / 1 Ml In 1 Vial,636,RC,42023-116-25,NDC,,,facility,both,1,EA,,6.51,6.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-159-01,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adrenalin: 25 Vial In 1 Carton (42023-159-25)  / 1 Ml In 1 Vial (42023-159-01),636,RC,42023-159-25,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (39822-1100-1)  / 10 Ml In 1 Vial, Multi-Dose",636,RC,39822-1100-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adrenalin: 1 Vial In 1 Carton (42023-168-01)  / 30 Ml In 1 Vial,636,RC,42023-168-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-179-01,NDC,,,facility,both,1,EA,,7.79,7.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-230-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-230-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-237-01,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-164-01,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amphotericin B: 10 Ml In 1 Vial (39822-1055-5),636,RC,39822-1055-5,NDC,,,facility,both,1,EA,,68.23,68.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 40 Bag In 1 Carton (36000-306-60)  / 100 Ml In 1 Bag,636,RC,36000-306-60,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,36000-308-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,36000-310-01,NDC,,,facility,both,1,EA,,15.13,15.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naloxone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (36000-310-02)  / 10 Ml In 1 Vial, Multi-Dose (36000-310-01)",636,RC,36000-310-02,NDC,,,facility,both,1,EA,,15.13,15.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1)  / 5 Ml In 1 Vial, Glass",636,RC,39822-0190-1,NDC,,,facility,both,1,EA,,38.19,38.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1)  / 5 Ml In 1 Vial, Glass",636,RC,39822-0190-1,NDC,,,facility,both,1,EA,,33.05,33.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass",636,RC,25682-028-01,NDC,,,facility,both,1,EA,,418.39,418.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 25 Vial In 1 Carton (25021-608-20)  / 20 Ml In 1 Vial,636,RC,25021-608-20,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midazolam: 10 Vial In 1 Carton (25021-661-10)  / 10 Ml In 1 Vial,636,RC,25021-661-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pentobarbital Sodium: 1 Vial In 1 Carton (25021-676-50)  / 50 Ml In 1 Vial,636,RC,25021-676-50,NDC,,,facility,both,1,EA,,37.77,37.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pantoprazole Sodium: 10 Vial In 1 Carton (25021-751-10)  / 10 Ml In 1 Vial,636,RC,25021-751-10,NDC,,,facility,both,1,EA,,2.66,2.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Edisylate: 10 Vial In 1 Carton (25021-790-02)  / 2 Ml In 1 Vial,636,RC,25021-790-02,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Edisylate: 10 Vial In 1 Carton (25021-790-02)  / 2 Ml In 1 Vial,636,RC,25021-790-02,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 10 Vial, Glass In 1 Carton (25021-791-20)  / 20 Ml In 1 Vial, Glass",636,RC,25021-791-20,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetylcysteine: 4 Vial In 1 Carton (25021-812-30)  / 30 Ml In 1 Vial,636,RC,25021-812-30,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetylcysteine: 4 Vial In 1 Carton (25021-812-30)  / 30 Ml In 1 Vial,636,RC,25021-812-30,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fomepizole: 1 Vial In 1 Carton (25021-829-02)  / 1.5 Ml In 1 Vial,636,RC,25021-829-02,NDC,,,facility,both,1,EA,,5.87,5.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial,636,RC,25682-001-01,NDC,,,facility,both,1,EA,,85.23,85.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial,636,RC,25682-001-01,NDC,,,facility,both,1,EA,,426.17,426.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass",636,RC,25682-028-01,NDC,,,facility,both,1,EA,,418.39,418.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,31722-205-31,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial,636,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial,636,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial,636,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 473 Ml In 1 Bottle (31722-681-47),636,RC,31722-681-47,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42023-237-01,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adrenalin (Epinephrine In Sodium Chloride): 10 Bag In 1 Carton (42023-315-10)  / 250 Ml In 1 Bag (42023-315-01),636,RC,42023-315-10,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43528-003-01,NDC,,,facility,both,1,EA,,258.2,258.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43393-001-01,NDC,,,facility,both,1,EA,,83.24,83.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (42858-502-03),636,RC,42858-502-03,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (42858-502-03),636,RC,42858-502-03,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dronabinol: 60 Capsule In 1 Bottle (42858-867-06),636,RC,42858-867-06,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43066-090-01,NDC,,,facility,both,1,EA,,4.88,4.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nexterone: 100 Ml In 1 Bag (43066-150-10),636,RC,43066-150-10,NDC,,,facility,both,1,EA,,8.82,8.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nexterone: 200 Ml In 1 Bag (43066-360-20),636,RC,43066-360-20,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Phosphate: 24 Bag In 1 Case (43066-995-24)  / 50 Ml In 1 Bag,636,RC,43066-995-24,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed Disodium: 1 Vial, Single-Dose In 1 Carton (43598-386-62)  / 4 Ml In 1 Vial, Single-Dose",636,RC,43598-386-62,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed Disodium: 1 Vial, Single-Dose In 1 Carton (43598-387-11)  / 20 Ml In 1 Vial, Single-Dose",636,RC,43598-387-11,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed Disodium: 1 Vial, Single-Dose In 1 Carton (43598-387-11)  / 20 Ml In 1 Vial, Single-Dose",636,RC,43598-387-11,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43598-405-11,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed Disodium: 1 Vial, Single-Dose In 1 Carton (43598-386-62)  / 4 Ml In 1 Vial, Single-Dose",636,RC,43598-386-62,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neostigmine: 1 Vial, Multi-Dose In 1 Carton (43598-529-11)  / 10 Ml In 1 Vial, Multi-Dose",636,RC,43598-529-11,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (43598-051-11)  / 2 Ml In 1 Vial, Multi-Dose",636,RC,43598-051-11,NDC,,,facility,both,1,EA,,761.85,761.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Vial In 1 Carton (43598-053-11)  / 10 Ml In 1 Vial,636,RC,43598-053-11,NDC,,,facility,both,1,EA,,5.66,5.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diazepam: 10 Syringe, Glass In 1 Carton (43598-106-10)  / 2 Ml In 1 Syringe, Glass (43598-106-11)",636,RC,43598-106-10,NDC,,,facility,both,1,EA,,6.77,6.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43598-106-11,NDC,,,facility,both,1,EA,,14.4,14.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43547-543-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42494-415-01,NDC,,,facility,both,1,EA,,20.25,20.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,42494-416-01,NDC,,,facility,both,1,EA,,31.65,31.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Crysvita: 1 Ml In 1 Vial, Single-Use (42747-102-01)",636,RC,42747-102-01,NDC,,,facility,both,1,EA,,872.49,872.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Thiamine Hydrochloride: 25 Vial In 1 Carton (25021-500-02)  / 2 Ml In 1 Vial,636,RC,25021-500-02,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Crysvita: 1 Ml In 1 Vial, Single-Use (42747-102-01)",636,RC,42747-102-01,NDC,,,facility,both,1,EA,,870.58,870.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Crysvita: 1 Ml In 1 Vial, Single-Use (42747-203-01)",636,RC,42747-203-01,NDC,,,facility,both,1,EA,,872.49,872.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Crysvita: 1 Ml In 1 Vial, Single-Use (42747-203-01)",636,RC,42747-203-01,NDC,,,facility,both,1,EA,,872.49,872.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Crysvita: 1 Ml In 1 Vial, Single-Use (42747-304-01)",636,RC,42747-304-01,NDC,,,facility,both,1,EA,,872.49,872.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Crysvita: 1 Ml In 1 Vial, Single-Use (42747-304-01)",636,RC,42747-304-01,NDC,,,facility,both,1,EA,,854,854,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 30 Ml In 1 Bottle, Plastic (42806-151-34)",636,RC,42806-151-34,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Thiamine Hydrochloride: 25 Vial In 1 Carton (25021-500-02)  / 2 Ml In 1 Vial,636,RC,25021-500-02,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-671-65,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Capsule In 1 Bottle (16729-042-01),636,RC,16729-042-01,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Capsule In 1 Bottle (16729-043-01),636,RC,16729-043-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Capsule In 1 Bottle (16729-043-01),636,RC,16729-043-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-08)  / 25 Ml In 1 Vial, Multi-Dose",636,RC,16729-114-08,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Palonosetron: 1 Vial, Single-Use In 1 Carton (16714-834-01)  / 5 Ml In 1 Vial, Single-Use",636,RC,16714-834-01,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Carton (16714-977-20)  / 50 Ml In 1 Vial (16714-977-01),636,RC,16714-977-20,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 1 Bottle, Plastic In 1 Carton (16714-671-02)  / 50 Ml In 1 Bottle, Plastic",636,RC,16714-671-02,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 1 Bottle, Plastic In 1 Carton (16714-671-02)  / 50 Ml In 1 Bottle, Plastic",636,RC,16714-671-02,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
1 BOTTLE in 1 CARTON (16714-671-01)  / 50 mL in 1 BOTTLE,636,RC,16714-671-01,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-301-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,16714-248-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Vial In 1 Carton (16714-140-01)  / 5 Ml In 1 Vial,636,RC,16714-140-01,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (16714-159-01)",636,RC,16714-159-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-200-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,16714-248-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43598-548-50,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 1 Vial In 1 Carton (16729-277-30)  / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 1 Vial In 1 Carton (16729-277-30)  / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,6.36,6.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (25021-052-05)  / 5 Ml In 1 Vial,636,RC,25021-052-05,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (25021-052-05)  / 5 Ml In 1 Vial,636,RC,25021-052-05,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 25 VIAL in 1 CARTON (25021-101-67)  / 3 mL in 1 VIAL,636,RC,25021-101-67,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 25 VIAL in 1 CARTON (25021-106-67)  / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL",636,RC,25021-106-67,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 25 Vial In 1 Carton (25021-107-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,25021-107-20,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 24 Pouch In 1 Carton (25021-114-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-114-87,NDC,,,facility,both,1,EA,,3,3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin: 25 Vial In 1 Carton (25021-115-04)  / 4 Ml In 1 Vial,636,RC,25021-115-04,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 10 Vial In 1 Carton (25021-121-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,25021-121-20,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 25 VIAL in 1 CARTON (25021-101-67)  / 3 mL in 1 VIAL,636,RC,25021-101-67,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 Pouch In 1 Carton (25021-131-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-131-82,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levofloxacin: 24 Pouch In 1 Carton (25021-132-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-132-82,NDC,,,facility,both,1,EA,,7.19,7.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Carton (25021-311-04)  / 4 Ml In 1 Vial,636,RC,25021-311-04,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Carton (25021-311-04)  / 4 Ml In 1 Vial,636,RC,25021-311-04,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Carton (25021-311-04)  / 4 Ml In 1 Vial,636,RC,25021-311-04,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adenosine: 10 Vial In 1 Carton (25021-318-02)  / 2 Ml In 1 Vial,636,RC,25021-318-02,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial,636,RC,25021-321-04,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial,636,RC,25021-321-04,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial,636,RC,25021-321-04,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Esmolol Hydrochloride: 10 Bag In 1 Carton (25021-308-84)  / 250 Ml In 1 Bag,636,RC,25021-308-84,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial,636,RC,25021-321-04,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-10)  / 10 Ml In 1 Vial,636,RC,25021-321-10,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Carton (25021-400-30)  / 30 Ml In 1 Vial,636,RC,25021-400-30,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Carton (25021-402-01)  / 1 Ml In 1 Vial,636,RC,25021-402-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Carton (25021-402-01)  / 1 Ml In 1 Vial,636,RC,25021-402-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Eptifibatide: 1 Vial In 1 Carton (25021-408-51)  / 100 Ml In 1 Vial,636,RC,25021-408-51,NDC,,,facility,both,1,EA,,30.12,30.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 10 Syringe In 1 Carton (25021-411-70)  / .8 Ml In 1 Syringe,636,RC,25021-411-70,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 10 Vial In 1 Carton (25021-321-10)  / 10 Ml In 1 Vial,636,RC,25021-321-10,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-20)  / 18 Ml In 1 Vial,636,RC,25021-305-20,NDC,,,facility,both,1,EA,,55.1,55.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levofloxacin: 24 Pouch In 1 Carton (25021-132-83)  / 1 Bag In 1 Pouch / 150 Ml In 1 Bag,636,RC,25021-132-83,NDC,,,facility,both,1,EA,,4.74,4.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Carton (25021-136-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,25021-136-10,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (25021-142-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,25021-142-20,NDC,,,facility,both,1,EA,,9.93,9.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Pouch In 1 Carton (25021-184-67)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-184-67,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Pouch In 1 Carton (25021-184-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-184-82,NDC,,,facility,both,1,EA,,6.7,6.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Pouch In 1 Carton (25021-184-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-184-87,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Micafungin: 1 Vial In 1 Carton (25021-190-10)  / 5 Ml In 1 Vial,636,RC,25021-190-10,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Micafungin: 1 Vial In 1 Carton (25021-191-10)  / 5 Ml In 1 Vial,636,RC,25021-191-10,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-192-82,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-192-87,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluorouracil: 1 Bottle In 1 Carton (25021-215-99)  / 100 Ml In 1 Bottle,636,RC,25021-215-99,NDC,,,facility,both,1,EA,,7.72,7.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Docetaxel: 1 Vial In 1 Carton (25021-245-04)  / 4 Ml In 1 Vial,636,RC,25021-245-04,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Docetaxel: 1 Vial In 1 Carton (25021-245-04)  / 4 Ml In 1 Vial,636,RC,25021-245-04,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paclitaxel: 1 Vial In 1 Carton (25021-255-50)  / 50 Ml In 1 Vial,636,RC,25021-255-50,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-20)  / 18 Ml In 1 Vial,636,RC,25021-305-20,NDC,,,facility,both,1,EA,,50.33,50.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levofloxacin: 24 Pouch In 1 Carton (25021-132-81)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag,636,RC,25021-132-81,NDC,,,facility,both,1,EA,,12.65,12.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadone Hydrochloride: 20 mL in 1 VIAL, MULTI-DOSE (17478-380-20) ",636,RC,17478-380-20,NDC,,,facility,both,1,EA,,13.88,13.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,18657-117-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,18657-117-02,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hylenex Recombinant: 4 Box In 1 Carton (18657-117-04)  / 1 Vial In 1 Box (18657-117-02)  / 1 Ml In 1 Vial (18657-117-01),636,RC,18657-117-04,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,19515-810-41,NDC,,,facility,both,1,EA,,27.31,27.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52)  / .5 Ml In 1 Syringe (19515-810-41),636,RC,19515-810-52,NDC,,,facility,both,1,EA,,28.52,28.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,19515-904-41,NDC,,,facility,both,1,EA,,26.46,26.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,19515-904-41,NDC,,,facility,both,1,EA,,26.14,26.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,19515-904-41,NDC,,,facility,both,1,EA,,26.18,26.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flulaval 2025/2026: 10 Syringe In 1 Carton (19515-904-52)  / .5 Ml In 1 Syringe (19515-904-41),636,RC,19515-904-52,NDC,,,facility,both,1,EA,,26.46,26.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,19515-810-41,NDC,,,facility,both,1,EA,,28.52,28.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 30 Bag In 1 Case (17271-720-05)  / 250 Ml In 1 Bag,636,RC,17271-720-05,NDC,,,facility,both,1,EA,,5.03,5.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 500 Ml In 1 Bag (17271-701-06),636,RC,17271-701-06,NDC,,,facility,both,1,EA,,6.79,6.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cisplatin: 100 Ml In 1 Vial (16729-288-38),636,RC,16729-288-38,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 100 Tablet In 1 Bottle (16729-486-01),636,RC,16729-486-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 100 Tablet In 1 Bottle (16729-486-01),636,RC,16729-486-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 1 Vial, Single-Dose In 1 Carton (16729-526-63)  / 1 Ml In 1 Vial, Single-Dose",636,RC,16729-526-63,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (17271-701-05),636,RC,17271-701-05,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (17271-701-05),636,RC,17271-701-05,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-547-31,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-547-31,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ondansetron: 25 Vial In 1 Carton (23155-547-42)  / 2 Ml In 1 Vial (23155-547-31),636,RC,23155-547-42,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ondansetron: 1 Vial In 1 Carton (23155-549-31)  / 20 Ml In 1 Vial,636,RC,23155-549-31,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose",636,RC,23155-594-31,NDC,,,facility,both,1,EA,,28.73,28.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-839-11,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,24201-100-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 24 Vial, Glass In 1 Carton (24201-100-24)  / 100 Ml In 1 Vial, Glass",636,RC,24201-100-24,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (24201-400-02)  / 2 Ml In 1 Vial, Multi-Dose",636,RC,24201-400-02,NDC,,,facility,both,1,EA,,1301.27,1301.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methotrexate: 1 Vial In 1 Carton (16729-277-30)  / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,3.05,3.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-473-32,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-240-31,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-290-32,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-294-31,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-294-31,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 5 Ml In 1 Vial, Glass (23155-313-31)",636,RC,23155-313-31,NDC,,,facility,both,1,EA,,28.21,28.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-345-32,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-473-32,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,23155-473-32,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Invega Sustenna: 1 Syringe In 1 Kit (50458-564-01)  / 1.5 Ml In 1 Syringe,636,RC,50458-564-01,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Invega Sustenna: 1 Syringe In 1 Kit (50458-564-01)  / 1.5 Ml In 1 Syringe,636,RC,50458-564-01,NDC,,,facility,both,1,EA,,13.78,13.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Invega Sustenna: 1 Syringe In 1 Kit (50458-563-01)  / 1 Ml In 1 Syringe,636,RC,50458-563-01,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Invega Sustenna: 1 Syringe In 1 Kit (50458-563-01)  / 1 Ml In 1 Syringe,636,RC,50458-563-01,NDC,,,facility,both,1,EA,,3.31,3.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 1 BOTTLE, GLASS in 1 CARTON (50383-741-20)  / 20 mL in 1 BOTTLE, GLASS",636,RC,50383-741-20,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01),636,RC,50419-423-01,NDC,,,facility,both,1,EA,,1856.51,1856.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01),636,RC,50419-423-01,NDC,,,facility,both,1,EA,,1781.59,1781.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Kyleena: 1 Intrauterine Device In 1 Carton (50419-424-01),636,RC,50419-424-01,NDC,,,facility,both,1,EA,,2340.19,2340.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spravato: 3 Blister Pack In 1 Kit (50458-028-03)  / 1 Vial, Single-Use In 1 Blister Pack / .2 Ml In 1 Vial, Single-Use (50458-028-00)",636,RC,50458-028-03,NDC,,,facility,both,1,EA,,2195.88,2195.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Risperdal Consta: 1 Kit In 1 Box (50458-306-11)  *  2 Ml In 1 Syringe (50458-306-01)  *  2 Ml In 1 Vial,636,RC,50458-306-11,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Risperdal Consta: 1 Kit In 1 Box (50458-308-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-308-01),636,RC,50458-308-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Risperdal Consta: 1 Kit In 1 Box (50458-308-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-308-01),636,RC,50458-308-11,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Invega Sustenna: 1 Syringe In 1 Kit (50458-562-01)  / .75 Ml In 1 Syringe,636,RC,50458-562-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50474-970-63,NDC,,,facility,both,1,EA,,8.85,8.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-078-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rabavert: 1 Kit In 1 Carton (50632-010-01)  *  1 Ml In 1 Syringe (50632-011-01)  *  1 Ml In 1 Vial, Glass (50632-013-01)",636,RC,50632-010-01,NDC,,,facility,both,1,EA,,706.11,706.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rabavert: 1 Kit In 1 Carton (50632-010-01)  *  1 Ml In 1 Syringe (50632-011-01)  *  1 Ml In 1 Vial, Glass (50632-013-01)",636,RC,50632-010-01,NDC,,,facility,both,1,EA,,651.12,651.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50632-013-01,NDC,,,facility,both,1,EA,,779.32,779.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50632-013-01,NDC,,,facility,both,1,EA,,713.63,713.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cabergoline: 8 Tablet In 1 Bottle (50742-118-08),636,RC,50742-118-08,NDC,,,facility,both,1,EA,,2.65,2.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50268-685-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50268-718-11,NDC,,,facility,both,1,EA,,13.61,13.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,52544-931-07,NDC,,,facility,both,1,EA,,25.43,25.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,52544-931-07,NDC,,,facility,both,1,EA,,24.88,24.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Caffeine Citrate: 1 Vial In 1 Carton (51754-0500-1)  / 3 Ml In 1 Vial,636,RC,51754-0500-1,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51991-144-99,NDC,,,facility,both,1,EA,,29.44,29.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51991-379-99,NDC,,,facility,both,1,EA,,7.54,7.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-817-01,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-817-01,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-670-01,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-670-01,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-721-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,51079-721-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (16714-137-01)  / 50 Ml In 1 Vial, Multi-Dose",636,RC,16714-137-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,45802-759-00,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,47335-931-40,NDC,,,facility,both,1,EA,,13.62,13.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,47335-932-40,NDC,,,facility,both,1,EA,,153.63,153.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vecuronium Bromide: 10 Vial In 1 Box (47335-932-44)  / 20 Ml In 1 Vial (47335-932-40),636,RC,47335-932-44,NDC,,,facility,both,1,EA,,153.63,153.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 1 Bag In 1 Pouch (47335-993-01)  / 100 Ml In 1 Bag,636,RC,47335-993-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 1 Bag In 1 Pouch (47335-993-01)  / 100 Ml In 1 Bag,636,RC,47335-993-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-049-40)  / 10 Ml In 1 Vial, Single-Dose",636,RC,47335-049-40,NDC,,,facility,both,1,EA,,365.99,365.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinvanti: 1 Vial, Glass In 1 Carton (47426-201-01)  / 18 Ml In 1 Vial, Glass",636,RC,47426-201-01,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinvanti: 1 Vial, Glass In 1 Carton (47426-201-01)  / 18 Ml In 1 Vial, Glass",636,RC,47426-201-01,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,47781-355-11,NDC,,,facility,both,1,EA,,3.46,3.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-124-88,NDC,,,facility,both,1,EA,,135.29,135.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-124-88,NDC,,,facility,both,1,EA,,132.61,132.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-125-65)  / .5 Ml In 1 Syringe, Glass (49281-125-88)",636,RC,49281-125-65,NDC,,,facility,both,1,EA,,101.47,101.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-125-88,NDC,,,facility,both,1,EA,,100.99,100.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-125-88,NDC,,,facility,both,1,EA,,100.53,100.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-215-88,NDC,,,facility,both,1,EA,,80.39,80.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-215-88,NDC,,,facility,both,1,EA,,76.35,76.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-286-58,NDC,,,facility,both,1,EA,,54.09,54.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Adacel Tdap: 10 Vial In 1 Package (49281-400-10)  / .5 Ml In 1 Vial (49281-400-58),636,RC,49281-400-10,NDC,,,facility,both,1,EA,,92.26,92.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-419-88,NDC,,,facility,both,1,EA,,21.58,21.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-423-88,NDC,,,facility,both,1,EA,,33.78,33.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Beyfortus: 1 Syringe In 1 Carton (49281-575-00)  / .5 Ml In 1 Syringe,636,RC,49281-575-00,NDC,,,facility,both,1,EA,,1017.57,1017.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftazidime: 25 Vial In 1 Carton (44567-235-25)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-235-25,NDC,,,facility,both,1,EA,,2.64,2.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftazidime: 25 Vial In 1 Carton (44567-235-25)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-235-25,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftazidime: 10 Vial In 1 Carton (44567-236-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-236-10,NDC,,,facility,both,1,EA,,2.65,2.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftazidime: 10 Vial In 1 Carton (44567-236-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-236-10,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefepime: 10 Vial In 1 Carton (44567-240-10)  / 20 Ml In 1 Vial,636,RC,44567-240-10,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefepime: 10 Vial In 1 Carton (44567-241-10)  / 20 Ml In 1 Vial,636,RC,44567-241-10,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefoxitin: 25 Vial In 1 Carton (44567-246-25)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-246-25,NDC,,,facility,both,1,EA,,6.42,6.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Tray (44567-102-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-102-10,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin G Potassium: 10 Vial In 1 Tray (44567-311-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-311-10,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-312-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-401-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-401-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-401-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-401-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (44567-401-10)  / 1 Injection, Powder, For Solution In 1 Vial (44567-401-01)",636,RC,44567-401-10,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Bag In 1 Carton (44567-410-24)  / 100 Ml In 1 Bag,636,RC,44567-410-24,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Tray (44567-101-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-101-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43598-636-52,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43598-901-11,NDC,,,facility,both,1,EA,,14.34,14.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,43598-901-11,NDC,,,facility,both,1,EA,,14.4,14.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ertapenem Sodium: 10 Vial, Single-Dose In 1 Carton (43598-901-58)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (43598-901-11)",636,RC,43598-901-58,NDC,,,facility,both,1,EA,,14.46,14.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rhophylac: 1 Syringe, Glass In 1 Carton (44206-300-01)  / 2 Ml In 1 Syringe, Glass (44206-300-90)",636,RC,44206-300-01,NDC,,,facility,both,1,EA,,137.91,137.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44206-300-90,NDC,,,facility,both,1,EA,,141.63,141.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Bag In 1 Carton (44567-410-24)  / 100 Ml In 1 Bag,636,RC,44567-410-24,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-420-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag,636,RC,44567-420-24,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49281-590-58,NDC,,,facility,both,1,EA,,333.12,333.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-421-24)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,44567-421-24,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-450-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-611-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-620-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-620-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 25 Vial In 1 Carton (44567-701-25)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-701-25,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-705-01,NDC,,,facility,both,1,EA,,19.07,19.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 Vial In 1 Carton (44567-707-25)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-707-25,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 Vial In 1 Carton (44567-707-25)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-707-25,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-801-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-801-10,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-820-01,NDC,,,facility,both,1,EA,,15.16,15.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-820-01,NDC,,,facility,both,1,EA,,18.96,18.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,44567-840-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,50242-136-01,NDC,,,facility,both,1,EA,,12.57,12.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,50242-136-01,NDC,,,facility,both,1,EA,,12.62,12.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,12.6,12.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,12.73,12.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,12.62,12.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,12.54,12.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,12.62,12.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,31.72,31.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,30.46,30.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,50242-136-01,NDC,,,facility,both,1,EA,,12.61,12.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-214-01)  / .5 Ml In 1 Syringe, Glass",636,RC,50242-214-01,NDC,,,facility,both,1,EA,,91.5,91.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-214-01)  / .5 Ml In 1 Syringe, Glass",636,RC,50242-214-01,NDC,,,facility,both,1,EA,,90.82,90.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-214-01)  / .5 Ml In 1 Syringe, Glass",636,RC,50242-214-01,NDC,,,facility,both,1,EA,,92.52,92.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-214-03)  / .5 Ml In 1 Syringe, Glass",636,RC,50242-214-03,NDC,,,facility,both,1,EA,,92.52,92.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-214-03)  / .5 Ml In 1 Syringe, Glass",636,RC,50242-214-03,NDC,,,facility,both,1,EA,,95.73,95.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-01)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-01,NDC,,,facility,both,1,EA,,91.13,91.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-01)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-01,NDC,,,facility,both,1,EA,,92.52,92.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-01)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-01,NDC,,,facility,both,1,EA,,90.99,90.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-01)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-01,NDC,,,facility,both,1,EA,,92.52,92.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-03)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-03,NDC,,,facility,both,1,EA,,92.52,92.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-03)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-03,NDC,,,facility,both,1,EA,,94.74,94.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-214-01)  / .5 Ml In 1 Syringe, Glass",636,RC,50242-214-01,NDC,,,facility,both,1,EA,,92.38,92.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-135-01,NDC,,,facility,both,1,EA,,12.5,12.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-135-01,NDC,,,facility,both,1,EA,,12.58,12.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-135-01,NDC,,,facility,both,1,EA,,12.62,12.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-060-01,NDC,,,facility,both,1,EA,,12.15,12.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-060-01,NDC,,,facility,both,1,EA,,123.3,123.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-060-01,NDC,,,facility,both,1,EA,,72.77,72.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-061-01)  / 16 Ml In 1 Vial, Single-Use",636,RC,50242-061-01,NDC,,,facility,both,1,EA,,152.39,152.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-061-01)  / 16 Ml In 1 Vial, Single-Use",636,RC,50242-061-01,NDC,,,facility,both,1,EA,,152.39,152.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-061-01)  / 16 Ml In 1 Vial, Single-Use",636,RC,50242-061-01,NDC,,,facility,both,1,EA,,152.1,152.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lucentis: 1 Syringe, Glass In 1 Carton (50242-080-03)  / .05 Ml In 1 Syringe, Glass",636,RC,50242-080-03,NDC,,,facility,both,1,EA,,764.4,764.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lucentis: 1 Syringe, Glass In 1 Carton (50242-080-03)  / .05 Ml In 1 Syringe, Glass",636,RC,50242-080-03,NDC,,,facility,both,1,EA,,761.06,761.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-085-25,NDC,,,facility,both,1,EA,,167.31,167.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-085-25,NDC,,,facility,both,1,EA,,167.31,167.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-085-25,NDC,,,facility,both,1,EA,,167.31,167.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Vial In 1 Carton (50242-096-01)  / .05 Ml In 1 Vial (50242-096-03),636,RC,50242-096-01,NDC,,,facility,both,1,EA,,74.22,74.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Vial In 1 Carton (50242-096-01)  / .05 Ml In 1 Vial (50242-096-03),636,RC,50242-096-01,NDC,,,facility,both,1,EA,,73.62,73.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Vial In 1 Carton (50242-096-01)  / .05 Ml In 1 Vial (50242-096-03),636,RC,50242-096-01,NDC,,,facility,both,1,EA,,74.89,74.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Vial In 1 Carton (50242-096-01)  / .05 Ml In 1 Vial (50242-096-03),636,RC,50242-096-01,NDC,,,facility,both,1,EA,,73.94,73.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Syringe In 1 Carton (50242-096-06)  / .05 Ml In 1 Syringe,636,RC,50242-096-06,NDC,,,facility,both,1,EA,,75.49,75.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Syringe In 1 Carton (50242-096-06)  / .05 Ml In 1 Syringe,636,RC,50242-096-06,NDC,,,facility,both,1,EA,,75.44,75.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vabysmo: 1 Syringe In 1 Carton (50242-096-06)  / .05 Ml In 1 Syringe,636,RC,50242-096-06,NDC,,,facility,both,1,EA,,4487.72,4487.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-100-39,NDC,,,facility,both,1,EA,,100.96,100.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pulmozyme: 5 Pouch In 1 Carton (50242-100-40)  / 6 Ampule In 1 Pouch (50242-100-39)  / 2.5 Ml In 1 Ampule,636,RC,50242-100-40,NDC,,,facility,both,1,EA,,101.73,101.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-135-01,NDC,,,facility,both,1,EA,,12.48,12.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use",636,RC,50242-135-01,NDC,,,facility,both,1,EA,,12.74,12.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-03)  / 1 Ml In 1 Syringe, Glass",636,RC,50242-215-03,NDC,,,facility,both,1,EA,,94.26,94.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,156.52,156.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,184.44,184.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,179.5,179.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50268-162-11,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50268-163-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,184.68,184.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,179.96,179.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01)  / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,182.68,182.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01)  / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,183.78,183.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01)  / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,183.78,183.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01)  / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,180.21,180.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,183.78,183.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,157.45,157.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,156.52,156.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,159.04,159.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cabenuva: 1 Kit In 1 Carton (49702-253-15)  *  2 Ml In 1 Vial (49702-245-01)  *  2 Ml In 1 Vial (49702-249-02),636,RC,49702-253-15,NDC,,,facility,both,1,EA,,45,45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49884-159-52,NDC,,,facility,both,1,EA,,5.78,5.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49884-283-52,NDC,,,facility,both,1,EA,,4.75,4.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,49502-102-01,NDC,,,facility,both,1,EA,,85.85,85.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cytogam: 1 Vial, Glass In 1 Carton (49591-532-51)  / 50 Ml In 1 Vial, Glass (49591-532-50)",636,RC,49591-532-51,NDC,,,facility,both,1,EA,,3364.24,3364.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-037-06,NDC,,,facility,both,1,EA,,316.89,316.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-037-06,NDC,,,facility,both,1,EA,,311.87,311.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 10 Vial In 1 Carton (50242-041-10)  / 2 Ml In 1 Vial,636,RC,50242-041-10,NDC,,,facility,both,1,EA,,176.01,176.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,171.83,171.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,174.15,174.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,174.9,174.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,173.23,173.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,173.77,173.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-044-06,NDC,,,facility,both,1,EA,,167.31,167.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,50242-044-06,NDC,,,facility,both,1,EA,,167.31,167.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-051-21)  / 10 Ml In 1 Vial, Single-Use",636,RC,50242-051-21,NDC,,,facility,both,1,EA,,156.52,156.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-789-10)",636,RC,50111-789-10,NDC,,,facility,both,1,EA,,8.33,8.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Vial In 1 Carton (16714-130-01)  / 1 Ml In 1 Vial,636,RC,16714-130-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Vial In 1 Carton (16714-130-01)  / 1 Ml In 1 Vial,636,RC,16714-130-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0476-21,NDC,,,facility,both,1,EA,,26.39,26.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0477-21,NDC,,,facility,both,1,EA,,51.24,51.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0928-21,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Promethazine Hydrochloride: 25 Vial In 1 Carton (0641-0955-25)  / 1 Ml In 1 Vial (0641-0955-21),636,RC,0641-0955-25,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-1397-31,NDC,,,facility,both,1,EA,,58.9,58.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-1410-31,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-1410-31,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0400-37,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6007-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6007-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6007-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6001-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21),636,RC,0641-0376-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21),636,RC,0641-0376-25,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Perphenazine: 100 Tablet, Film Coated In 1 Bottle, Plastic (0603-5060-21)",636,RC,0603-5060-21,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0367-21,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0376-21,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-0376-21,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midazolam: 10 Vial In 1 Carton (0641-6060-10)  / 10 Ml In 1 Vial (0641-6060-01),636,RC,0641-6060-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6061-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midazolam: 25 Vial In 1 Carton (0641-6061-25)  / 1 Ml In 1 Vial (0641-6061-01),636,RC,0641-6061-25,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ondansetron: 20 Ml In 1 Carton (0641-6079-01),636,RC,0641-6079-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6060-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6103-01,NDC,,,facility,both,1,EA,,12.34,12.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6103-01,NDC,,,facility,both,1,EA,,14.24,14.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6116-01,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6117-01,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6117-01,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6125-01,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6084-01,NDC,,,facility,both,1,EA,,2.9,2.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6059-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6027-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6027-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Citrate: 20 Ml In 1 Vial (0641-6029-01),636,RC,0641-6029-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Citrate: 50 Ml In 1 Vial (0641-6030-01),636,RC,0641-6030-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Infumorph 200: 20 Ml In 1 Ampule (0641-6039-01),636,RC,0641-6039-01,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Infumorph 500: 20 Ml In 1 Ampule (0641-6040-01),636,RC,0641-6040-01,NDC,,,facility,both,1,EA,,12.65,12.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6042-01,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6044-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6046-01,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6053-01,NDC,,,facility,both,1,EA,,3.01,3.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meperidine Hydrochloride: 25 Vial In 1 Carton (0641-6053-25)  / 1 Ml In 1 Vial (0641-6053-01),636,RC,0641-6053-25,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6057-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Praxbind: 2 Vial, Single-Dose In 1 Carton (0597-0197-05)  / 50 Ml In 1 Vial, Single-Dose",636,RC,0597-0197-05,NDC,,,facility,both,1,EA,,4975.37,4975.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rhogam Ultra-Filtered Plus: 1 Pouch In 1 Carton (0562-7805-01)  / 1 Injection, Solution In 1 Pouch (0562-7805-00)",636,RC,0562-7805-01,NDC,,,facility,both,1,EA,,161.87,161.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Medroxyprogesterone Acetate: 1 Vial, Single-Dose In 1 Carton (0548-5400-00)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0548-5400-00,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 10 Syringe In 1 Carton (0548-5601-00)  / .3 Ml In 1 Syringe,636,RC,0548-5601-00,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 10 Syringe In 1 Carton (0548-5606-00)  / .8 Ml In 1 Syringe,636,RC,0548-5606-00,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 1 Vial In 1 Carton (0548-5608-00)  / 3 Ml In 1 Vial,636,RC,0548-5608-00,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 1 Vial In 1 Carton (0548-5608-00)  / 3 Ml In 1 Vial,636,RC,0548-5608-00,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,36.12,36.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,36.15,36.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,34.06,34.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Perphenazine: 100 Tablet, Film Coated In 1 Bottle (0591-4103-01)",636,RC,0591-4103-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0597-0053-01,NDC,,,facility,both,1,EA,,285.59,285.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0597-0053-01,NDC,,,facility,both,1,EA,,135.66,135.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-3315-70)  / 10 Ml In 1 Vial, Single-Use",636,RC,0781-3315-70,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-3315-70)  / 10 Ml In 1 Vial, Single-Use",636,RC,0781-3315-70,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3404-85,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3407-78,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3408-80,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3411-70,NDC,,,facility,both,1,EA,,2.79,2.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-3315-70)  / 10 Ml In 1 Vial, Single-Use",636,RC,0781-3315-70,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3440-71,NDC,,,facility,both,1,EA,,51.52,51.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cosyntropin: 10 Vial In 1 Carton (0781-3440-95)  / 1 Ml In 1 Vial (0781-3440-71),636,RC,0781-3440-95,NDC,,,facility,both,1,EA,,57.55,57.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,15.04,15.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,18.89,18.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,14.89,14.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,18.89,18.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,14.47,14.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,18.89,18.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3433-46,NDC,,,facility,both,1,EA,,5.07,5.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3290-91,NDC,,,facility,both,1,EA,,5.69,5.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3289-91,NDC,,,facility,both,1,EA,,6.77,6.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ferumoxytol: 1 Vial, Single-Dose In 1 Carton (0781-3154-01)  / 17 Ml In 1 Vial, Single-Dose",636,RC,0781-3154-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ferumoxytol: 1 Vial, Single-Dose In 1 Carton (0781-3154-01)  / 17 Ml In 1 Vial, Single-Dose",636,RC,0781-3154-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Vial, Glass In 1 Carton (0781-3156-95)  / 100 Ml In 1 Vial, Glass (0781-3156-06)",636,RC,0781-3156-95,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3158-94,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial,636,RC,0781-3159-72,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial,636,RC,0781-3159-72,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial,636,RC,0781-3159-72,NDC,,,facility,both,1,EA,,4.46,4.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3289-91,NDC,,,facility,both,1,EA,,7.01,7.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3289-91,NDC,,,facility,both,1,EA,,7.01,7.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3545-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3114-91,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-9407-78,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-6153-94,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin G Potassium: 1 Vial In 1 Carton (0781-6136-94)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,0781-6136-94,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3545-25)  / 1 Ml In 1 Vial, Multi-Dose (0781-3545-10)",636,RC,0781-3545-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3545-25)  / 1 Ml In 1 Vial, Multi-Dose (0781-3545-10)",636,RC,0781-3545-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylprednisolone: 100 TABLET in 1 BOTTLE (0781-5022-01) ,636,RC,0781-5022-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylprednisolone: 100 TABLET in 1 BOTTLE (0781-5022-01) ,636,RC,0781-5022-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin G Potassium: 10 Vial In 1 Carton (0781-6135-95)  / 1 Injection, Powder, For Solution In 1 Vial (0781-6135-94)",636,RC,0781-6135-95,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin G Potassium: 1 Vial In 1 Carton (0781-6136-94)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,0781-6136-94,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3545-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3113-90,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6195-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6205-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6228-01,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6231-01,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6244-01,NDC,,,facility,both,1,EA,,14.75,14.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6176-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6267-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial,636,RC,0703-0018-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),636,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),636,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01),636,RC,0703-0110-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0113-03)  / 5 Ml In 1 Vial (0703-0113-01),636,RC,0703-0113-03,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial,636,RC,0703-0018-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6176-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6175-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Package (0641-6127-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6127-01)",636,RC,0641-6127-25,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6132-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6132-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6136-01,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6146-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6149-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 25 Vial, Single-Dose In 1 Carton (0641-6151-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6151-01)",636,RC,0641-6151-25,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 25 Vial, Single-Dose In 1 Carton (0641-6151-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6151-01)",636,RC,0641-6151-25,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6174-01,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6174-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6174-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6174-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6175-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0113-03)  / 5 Ml In 1 Vial (0703-0113-01),636,RC,0703-0113-03,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Triamcinolone Acetonide: 1 Vial, Single-Dose In 1 Carton (0703-0241-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0703-0241-01,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,0703-3671-01,NDC,,,facility,both,1,EA,,3.75,3.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3059-72,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3110-90,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0781-3113-90,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0641-6127-01,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,0703-3671-01,NDC,,,facility,both,1,EA,,11.09,11.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (0703-4246-01)  / 15 Ml In 1 Vial, Multi-Dose",636,RC,0703-4246-01,NDC,,,facility,both,1,EA,,10.35,10.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (0703-4248-01)  / 45 Ml In 1 Vial, Multi-Dose",636,RC,0703-4248-01,NDC,,,facility,both,1,EA,,11.63,11.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sulfamethoxazole And Trimethoprim: 10 Vial, Single-Dose In 1 Carton (0703-9503-03)  / 5 Ml In 1 Vial, Single-Dose (0703-9503-01)",636,RC,0703-9503-03,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0703-9514-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sulfamethoxazole And Trimethoprim: 1 Vial, Multi-Dose In 1 Carton (0703-9526-01)  / 30 Ml In 1 Vial, Multi-Dose",636,RC,0703-9526-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7337-11,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7338-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lmd In Dextrose: 12 Pouch In 1 Case (0409-7418-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag (0409-7418-13),636,RC,0409-7418-03,NDC,,,facility,both,1,EA,,53.9,53.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7418-13,NDC,,,facility,both,1,EA,,71.48,71.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7419-14,NDC,,,facility,both,1,EA,,46.09,46.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7517-66,NDC,,,facility,both,1,EA,,33.47,33.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7335-13,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7517-66,NDC,,,facility,both,1,EA,,22.06,22.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7650-05,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 24 Pouch In 1 Case (0409-7650-62)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-7650-52),636,RC,0409-7650-62,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7809-11,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 POUCH in 1 CASE (0409-7811-24)  / 1 BAG in 1 POUCH / 100 mL in 1 BAG (0409-7811-31) ,636,RC,0409-7811-24,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 POUCH in 1 CASE (0409-7811-24)  / 1 BAG in 1 POUCH / 100 mL in 1 BAG (0409-7811-31) ,636,RC,0409-7811-24,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 POUCH in 1 CASE (0409-7922-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG,636,RC,0409-7922-02,NDC,,,facility,both,1,EA,,9.76,9.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7620-13,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7335-13,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7332-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6653-18,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amidate: 10 Vial, Single-Dose In 1 Tray (0409-6695-01)  / 10 Ml In 1 Vial, Single-Dose (0409-6695-11)",636,RC,0409-6695-01,NDC,,,facility,both,1,EA,,8.75,8.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Pouch In 1 Case (0409-6727-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag (0409-6727-11),636,RC,0409-6727-23,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6729-11,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag (0409-6729-41),636,RC,0409-6729-23,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride in Sodium Chloride: 12 POUCH in 1 CASE (0409-7115-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7115-09,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC",636,RC,0409-7138-09,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Acetate: 25 Vial, Single-Dose In 1 Tray (0409-7299-73)  / 20 Ml In 1 Vial, Single-Dose (0409-7299-83)",636,RC,0409-7299-73,NDC,,,facility,both,1,EA,,6.47,6.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7299-83,NDC,,,facility,both,1,EA,,5.48,5.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone Sodium: 10 Vial, Single-Use In 1 Carton (0409-7332-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use (0409-7332-11)",636,RC,0409-7332-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-7332-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 POUCH in 1 CASE (0409-7922-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7922-09,NDC,,,facility,both,1,EA,,9,9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 BAG in 1 CASE (0409-7922-25)  / 250 mL in 1 BAG,636,RC,0409-7922-25,NDC,,,facility,both,1,EA,,3.73,3.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 20 POUCH in 1 CASE (0409-7923-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG,636,RC,0409-7923-37,NDC,,,facility,both,1,EA,,10.16,10.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG,636,RC,0409-7984-36,NDC,,,facility,both,1,EA,,3.38,3.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG,636,RC,0409-7984-37,NDC,,,facility,both,1,EA,,8.67,8.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride And Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-9042-01)  / 10 Ml In 1 Vial, Single-Dose (0409-9042-11)",636,RC,0409-9042-01,NDC,,,facility,both,1,EA,,405.72,405.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG,636,RC,0409-7984-36,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Citrate: 10 Ampule In 1 Cello Pack (0409-9093-32)  / 2 Ml In 1 Ampule (0409-9093-37),636,RC,0409-9093-32,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-9094-12,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-9094-16,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",636,RC,0409-9094-22,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",636,RC,0409-9094-22,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",636,RC,0409-9094-22,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-9094-41,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 BAG in 1 CASE (0409-7983-25)  / 250 mL in 1 BAG,636,RC,0409-7983-25,NDC,,,facility,both,1,EA,,12.34,12.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 POUCH in 1 CASE (0409-7983-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7983-09,NDC,,,facility,both,1,EA,,6.12,6.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose and Sodium Chloride: 24 POUCH in 1 CASE (0409-7926-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,636,RC,0409-7926-03,NDC,,,facility,both,1,EA,,10.78,10.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7926-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7926-09,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers and Dextrose: 12 POUCH in 1 CASE (0409-7929-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7929-09,NDC,,,facility,both,1,EA,,9.64,9.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7941-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7941-09,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7941-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7941-09,NDC,,,facility,both,1,EA,,5.53,5.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 POUCH in 1 CASE (0409-7953-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,636,RC,0409-7953-03,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 POUCH in 1 CASE (0409-7953-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,636,RC,0409-7953-03,NDC,,,facility,both,1,EA,,10.15,10.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 POUCH in 1 CASE (0409-7953-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7953-09,NDC,,,facility,both,1,EA,,5.39,5.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 POUCH in 1 CASE (0409-7953-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7953-09,NDC,,,facility,both,1,EA,,8.02,8.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG,636,RC,0409-7983-02,NDC,,,facility,both,1,EA,,13.26,13.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,636,RC,0409-7983-03,NDC,,,facility,both,1,EA,,10.78,10.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG,636,RC,0409-7983-03,NDC,,,facility,both,1,EA,,10.47,10.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 POUCH in 1 CASE (0409-7983-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG,636,RC,0409-7983-09,NDC,,,facility,both,1,EA,,5.62,5.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 20 POUCH in 1 CASE (0409-7923-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG,636,RC,0409-7923-36,NDC,,,facility,both,1,EA,,4.96,4.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6653-18,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6648-16,NDC,,,facility,both,1,EA,,5.98,5.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 1 Vial, Multi-Dose In 1 Carton (0409-4759-01)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,0409-4759-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4888-02,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4755-18,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4888-06,NDC,,,facility,both,1,EA,,4.5,4.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",636,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",636,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",636,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4928-11,NDC,,,facility,both,1,EA,,20.88,20.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Chloride: 10 Carton In 1 Container (0409-4928-34)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,0409-4928-34,NDC,,,facility,both,1,EA,,30.61,30.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4699-54,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4699-50,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4277-16,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4277-17,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4279-16,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)",636,RC,0409-4332-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4332-11,NDC,,,facility,both,1,EA,,4.25,4.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4332-11,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4520-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4520-02,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 10 Vial In 1 Tray (0409-4699-24)  / 100 Ml In 1 Vial (0409-4699-54),636,RC,0409-4699-24,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 5 Vial In 1 Carton (0409-4699-30)  / 20 Ml In 1 Vial (0409-4699-50),636,RC,0409-4699-30,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Tray (0409-4699-33)  / 50 Ml In 1 Vial (0409-4699-53),636,RC,0409-4699-33,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Tray (0409-4699-33)  / 50 Ml In 1 Vial (0409-4699-53),636,RC,0409-4699-33,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Epinephrine: 10 Carton In 1 Package (0409-4933-01)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4933-11)",636,RC,0409-4933-01,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-5084-13,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-5084-13,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-25)  / 2 Ml In 1 Vial, Single-Dose (0409-6102-35)",636,RC,0409-6102-25,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 24 BOTTLE, PLASTIC in 1 CASE (0409-6138-03)  / 500 mL in 1 BOTTLE, PLASTIC",636,RC,0409-6138-03,NDC,,,facility,both,1,EA,,10.61,10.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Erythrocin Lactobionate: 10 Vial In 1 Tray (0409-6482-01)  / 10 Ml In 1 Vial (0409-6482-11),636,RC,0409-6482-01,NDC,,,facility,both,1,EA,,25.94,25.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6482-11,NDC,,,facility,both,1,EA,,51.88,51.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6482-11,NDC,,,facility,both,1,EA,,50.55,50.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6531-11,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6531-12,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6533-11,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-6635-01)  / 5 Ml In 1 Vial, Single-Dose (0409-6635-18)",636,RC,0409-6635-01,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextrose: 25 Vial, Single-Dose In 1 Tray (0409-6648-02)  / 50 Ml In 1 Vial, Single-Dose (0409-6648-16)",636,RC,0409-6648-02,NDC,,,facility,both,1,EA,,8.25,8.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-25)  / 2 Ml In 1 Vial, Single-Dose (0409-6102-35)",636,RC,0409-6102-25,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-5820-11,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-5921-16,NDC,,,facility,both,1,EA,,4.2,4.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6010-02,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)",636,RC,0409-6102-04,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)",636,RC,0409-6102-04,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)",636,RC,0409-6102-04,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-18,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-18,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 25 Carton In 1 Tray (0409-9094-61)  / 1 Vial, Single-Dose In 1 Carton / 50 Ml In 1 Vial, Single-Dose (0409-9094-41)",636,RC,0409-9094-61,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-9158-31,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,15.28,15.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,24.21,24.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0517-4601-25,NDC,,,facility,both,1,EA,,3.37,3.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose",636,RC,0517-4602-25,NDC,,,facility,both,1,EA,,4.3,4.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose",636,RC,0517-4602-25,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-4810-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitroglycerin: 25 Vial, Single-Dose In 1 Tray (0517-4810-25)  / 10 Ml In 1 Vial, Single-Dose (0517-4810-01)",636,RC,0517-4810-25,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitroglycerin: 25 Vial, Single-Dose In 1 Tray (0517-4810-25)  / 10 Ml In 1 Vial, Single-Dose (0517-4810-01)",636,RC,0517-4810-25,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-5601-01,NDC,,,facility,both,1,EA,,19.8,19.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxyzine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0517-5601-25)  / 1 Ml In 1 Vial, Single-Dose (0517-5601-01)",636,RC,0517-5601-25,NDC,,,facility,both,1,EA,,18.54,18.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-6710-01,NDC,,,facility,both,1,EA,,14.48,14.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-9702-01,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,24.92,24.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,24.73,24.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Papaverine Hydrochloride: 25 Vial In 1 Carton (0517-4002-25)  / 2 Ml In 1 Vial (0517-4002-01),636,RC,0517-4002-25,NDC,,,facility,both,1,EA,,26.22,26.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ambisome: 12.5 Ml In 1 Vial, Single-Dose (0469-3051-30)",636,RC,0469-3051-30,NDC,,,facility,both,1,EA,,36.17,36.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ambisome: 12.5 Ml In 1 Vial, Single-Dose (0469-3051-30)",636,RC,0469-3051-30,NDC,,,facility,both,1,EA,,35.99,35.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyloy: 1 Vial In 1 Box (0469-3425-10)  / 5 Ml In 1 Vial,636,RC,0469-3425-10,NDC,,,facility,both,1,EA,,61.85,61.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0469-0420-01,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyloy: 1 Vial In 1 Box (0469-3425-10)  / 5 Ml In 1 Vial,636,RC,0469-3425-10,NDC,,,facility,both,1,EA,,35.93,35.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyloy: 1 Vial In 1 Box (0469-4425-30)  / 15 Ml In 1 Vial,636,RC,0469-4425-30,NDC,,,facility,both,1,EA,,62.72,62.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 473 Ml In 1 Bottle (0472-0082-16),636,RC,0472-0082-16,NDC,,,facility,both,1,EA,,6.81,6.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyloy: 1 Vial In 1 Box (0469-4425-30)  / 15 Ml In 1 Vial,636,RC,0469-4425-30,NDC,,,facility,both,1,EA,,62.36,62.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0469-0420-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avycaz: 10 Vial, Single-Dose In 1 Carton (0456-2700-10)  / 1 Powder, For Solution In 1 Vial, Single-Dose (0456-2700-01)",636,RC,0456-2700-10,NDC,,,facility,both,1,EA,,172.22,172.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0456-0400-01,NDC,,,facility,both,1,EA,,9.19,9.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0456-0600-01,NDC,,,facility,both,1,EA,,6.13,6.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0456-2700-01,NDC,,,facility,both,1,EA,,178.3,178.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0456-2700-01,NDC,,,facility,both,1,EA,,170.05,170.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0456-2700-01,NDC,,,facility,both,1,EA,,178.29,178.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0456-2700-01,NDC,,,facility,both,1,EA,,175.26,175.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avycaz: 10 Vial, Single-Dose In 1 Carton (0456-2700-10)  / 1 Powder, For Solution In 1 Vial, Single-Dose (0456-2700-01)",636,RC,0456-2700-10,NDC,,,facility,both,1,EA,,169.8,169.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Risperidone: 1 Kit In 1 Carton (0480-1453-08)  *  2 Ml In 1 Vial (0480-9735-01)  *  2 Ml In 1 Syringe (0480-1200-21),636,RC,0480-1453-08,NDC,,,facility,both,1,EA,,16.45,16.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (0487-0201-01)  / 1 Vial, Single-Use In 1 Pouch / 3 Ml In 1 Vial, Single-Use",636,RC,0487-0201-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-0901-01,NDC,,,facility,both,1,EA,,9.58,9.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-1001-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atropine Sulfate: 25 Vial, Glass In 1 Tray (0517-1001-25)  / 1 Ml In 1 Vial, Glass (0517-1001-01)",636,RC,0517-1001-25,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial,636,RC,0517-1820-01,NDC,,,facility,both,1,EA,,151.53,151.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial,636,RC,0517-1820-01,NDC,,,facility,both,1,EA,,138.19,138.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-1980-01,NDC,,,facility,both,1,EA,,30.19,30.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-2310-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-2310-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 5 Vial, Single-Dose In 1 Box (0517-2310-05)  / 10 Ml In 1 Vial, Single-Dose (0517-2310-01)",636,RC,0517-2310-05,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 5 Vial, Single-Dose In 1 Box (0517-2310-05)  / 10 Ml In 1 Vial, Single-Dose (0517-2310-01)",636,RC,0517-2310-05,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-10,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-10,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Betamethasone Sodium Phosphate And Betamethasone Acetate: 1 Vial, Multi-Dose In 1 Carton (0517-0720-01)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,0517-0720-01,NDC,,,facility,both,1,EA,,8.94,8.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-0374-01,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (0487-0201-01)  / 1 Vial, Single-Use In 1 Pouch / 3 Ml In 1 Vial, Single-Use",636,RC,0487-0201-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",636,RC,0487-9501-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",636,RC,0487-9501-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 6 Pouch In 1 Carton (0487-9601-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,636,RC,0487-9601-01,NDC,,,facility,both,1,EA,,8.23,8.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 6 Pouch In 1 Carton (0487-9601-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,636,RC,0487-9601-01,NDC,,,facility,both,1,EA,,8.46,8.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 6 Pouch In 1 Carton (0487-9701-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,636,RC,0487-9701-01,NDC,,,facility,both,1,EA,,16.82,16.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Budesonide: 6 Pouch In 1 Carton (0487-9701-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,636,RC,0487-9701-01,NDC,,,facility,both,1,EA,,16.73,16.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01)  / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose",636,RC,0487-9801-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01)  / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose",636,RC,0487-9801-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 25 Pouch In 1 Carton (0487-9904-25)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",636,RC,0487-9904-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albuterol Sulfate: 25 Pouch In 1 Carton (0487-9904-25)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",636,RC,0487-9904-25,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0517-0031-01,NDC,,,facility,both,1,EA,,12.3,12.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-0495-06,NDC,,,facility,both,1,EA,,12.64,12.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-0495-06,NDC,,,facility,both,1,EA,,23.8,23.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-0495-06,NDC,,,facility,both,1,EA,,26.52,26.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)",636,RC,0944-2700-02,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)",636,RC,0944-2700-02,NDC,,,facility,both,1,EA,,107.51,107.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)",636,RC,0944-2700-04,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)",636,RC,0944-2700-04,NDC,,,facility,both,1,EA,,106.48,106.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05)  / 100 Ml In 1 Bottle, Glass (0944-2700-11)",636,RC,0944-2700-05,NDC,,,facility,both,1,EA,,106.68,106.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06),636,RC,0944-0495-05,NDC,,,facility,both,1,EA,,31.5,31.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,104.22,104.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-07)  / 300 Ml In 1 Bottle, Glass (0944-2700-13)",636,RC,0944-2700-07,NDC,,,facility,both,1,EA,,106.68,106.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-08,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-08,NDC,,,facility,both,1,EA,,107.16,107.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-10,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-10,NDC,,,facility,both,1,EA,,107.18,107.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-11,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-11,NDC,,,facility,both,1,EA,,107.51,107.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-12,NDC,,,facility,both,1,EA,,107.51,107.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-13,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-2700-13,NDC,,,facility,both,1,EA,,107.14,107.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-07)  / 300 Ml In 1 Bottle, Glass (0944-2700-13)",636,RC,0944-2700-07,NDC,,,facility,both,1,EA,,76.64,76.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06),636,RC,0944-0495-05,NDC,,,facility,both,1,EA,,30.22,30.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03),636,RC,0944-0493-01,NDC,,,facility,both,1,EA,,62.12,62.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03),636,RC,0944-0493-01,NDC,,,facility,both,1,EA,,62.29,62.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-0493-03,NDC,,,facility,both,1,EA,,61.82,61.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-0493-03,NDC,,,facility,both,1,EA,,60.33,60.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-0493-03,NDC,,,facility,both,1,EA,,62.18,62.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06),636,RC,0944-0495-05,NDC,,,facility,both,1,EA,,12.45,12.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Advate: 1 Blister Pack In 1 Carton (0944-3053-02)  / 1 Container In 1 Blister Pack (0944-3053-04)  / 1 Kit In 1 Container (0944-3053-03)  *  5 Ml In 1 Vial, Glass (0944-2943-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)",636,RC,0944-3053-02,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0944-3053-04,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 20 Pouch In 1 Case (0990-7923-36)  / 4 Bag In 1 Pouch / 50 Ml In 1 Bag,636,RC,0990-7923-36,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Pouch In 1 Case (0990-7930-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag,636,RC,0990-7930-02,NDC,,,facility,both,1,EA,,9.76,9.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Pouch In 1 Case (0990-7935-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,636,RC,0990-7935-19,NDC,,,facility,both,1,EA,,24.8,24.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 Pouch In 1 Case (0990-7953-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,636,RC,0990-7953-03,NDC,,,facility,both,1,EA,,7.41,7.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Pouch In 1 Case (0990-7953-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,636,RC,0990-7953-09,NDC,,,facility,both,1,EA,,10.72,10.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Pouch In 1 Case (0990-7922-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,636,RC,0990-7922-09,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Pouch In 1 Case (0990-7983-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag,636,RC,0990-7983-02,NDC,,,facility,both,1,EA,,9.57,9.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 18 Pouch In 1 Case (0990-7983-55)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,636,RC,0990-7983-55,NDC,,,facility,both,1,EA,,14.54,14.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 60 BAG in 1 CASE (0990-7984-11)  / 100 mL in 1 BAG,636,RC,0990-7984-11,NDC,,,facility,both,1,EA,,6.26,6.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 48 Pouch In 1 Case (0990-7984-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,0990-7984-23,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 20 Pouch In 1 Case (0990-7984-36)  / 4 Bag In 1 Pouch / 50 Ml In 1 Bag,636,RC,0990-7984-36,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Brevibloc: 10 Bag In 1 Carton (10019-055-61)  / 250 Ml In 1 Bag,636,RC,10019-055-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10019-120-39,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Pouch In 1 Case (0990-7922-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,636,RC,0990-7922-03,NDC,,,facility,both,1,EA,,9.43,9.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Pouch In 1 Case (0990-7918-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag,636,RC,0990-7918-19,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0955-1004-01,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0955-1006-01,NDC,,,facility,both,1,EA,,3.38,3.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 24 Bottle, Plastic In 1 Case (0990-6138-22)  / 250 Ml In 1 Bottle, Plastic",636,RC,0990-6138-22,NDC,,,facility,both,1,EA,,9.8,9.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Pouch In 1 Case (0990-7074-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,0990-7074-26,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Pouch In 1 Case (0990-7075-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,0990-7075-26,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Pouch In 1 Case (0990-7075-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,0990-7075-26,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 6 Pouch In 1 Case (0990-7120-07)  / 1 Bag In 1 Pouch / 2000 Ml In 1 Bag,636,RC,0990-7120-07,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0990-7715-12,NDC,,,facility,both,1,EA,,7.44,7.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0990-7715-13,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0955-1004-01,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-7237-60),636,RC,0904-7237-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-7237-60),636,RC,0904-7237-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61)  / 10 Capsule In 1 Blister Pack",636,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61)  / 10 Capsule In 1 Blister Pack",636,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Promethazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7304-61)  / 1 Tablet In 1 Blister Pack,636,RC,0904-7304-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10019-120-39,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10019-953-62,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-72,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-72,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.44,68.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.8,68.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.89,68.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.32,68.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.93,68.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.3,68.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.83,68.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,69.01,69.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.8,68.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,68.16,68.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-25,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-25,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-25,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.96,68.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.13,68.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.93,68.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.21,68.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.94,68.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,68.35,68.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,14789-109-16,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-016-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-016-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-026-01,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-036-01,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,16714-006-01,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-048-01)",636,RC,16714-048-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-049-01)",636,RC,16714-049-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,14789-109-16,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,14789-116-07,NDC,,,facility,both,1,EA,,136.44,136.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Papaverine Hydrochloride: 10 Vial, Single-Use In 1 Carton (14789-121-05)  / 2 Ml In 1 Vial, Single-Use (14789-121-07)",636,RC,14789-121-05,NDC,,,facility,both,1,EA,,29.46,29.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,14789-127-07,NDC,,,facility,both,1,EA,,17.32,17.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenobarbital Sodium: 10 Vial, Glass In 1 Carton (14789-128-05)  / 1 Ml In 1 Vial, Glass (14789-128-07)",636,RC,14789-128-05,NDC,,,facility,both,1,EA,,35.81,35.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,14789-128-07,NDC,,,facility,both,1,EA,,28.36,28.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dysport: 1 Vial In 1 Carton (15054-0530-6)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,15054-0530-6,NDC,,,facility,both,1,EA,,17.26,17.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,14789-108-16,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-21,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-21,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,68.14,68.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (10019-955-01)  / 25 Ml In 1 Vial, Single-Dose (10019-955-50)",636,RC,10019-955-01,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (10019-955-01)  / 25 Ml In 1 Vial, Single-Dose (10019-955-50)",636,RC,10019-955-01,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10019-955-50,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (10019-956-01)  / 50 Ml In 1 Vial, Single-Dose (10019-956-16)",636,RC,10019-956-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (10019-956-01)  / 50 Ml In 1 Vial, Single-Dose (10019-956-16)",636,RC,10019-956-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10019-956-16,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10019-956-16,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10122-620-01,NDC,,,facility,both,1,EA,,35.18,35.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,10122-620-01,NDC,,,facility,both,1,EA,,36.06,36.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (10135-779-01),636,RC,10135-779-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (10135-779-01),636,RC,10135-779-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,68.94,68.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,68.44,68.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,68.37,68.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-13,NDC,,,facility,both,1,EA,,67.99,67.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-800-13,NDC,,,facility,both,1,EA,,67.99,67.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)",636,RC,13533-800-15,NDC,,,facility,both,1,EA,,69.01,69.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)",636,RC,13533-800-15,NDC,,,facility,both,1,EA,,69.01,69.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)",636,RC,13533-800-15,NDC,,,facility,both,1,EA,,69.01,69.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,68.74,68.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,68.21,68.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,67.98,67.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,68.98,68.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,69.01,69.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,68.15,68.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,68.75,68.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mesna: 1 Vial, Multi-Dose In 1 Box (10019-953-01)  / 10 Ml In 1 Vial, Multi-Dose (10019-953-62)",636,RC,10019-953-01,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,69,69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,68.62,68.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10),636,RC,13533-318-01,NDC,,,facility,both,1,EA,,628.88,628.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10),636,RC,13533-318-01,NDC,,,facility,both,1,EA,,409.21,409.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50),636,RC,13533-318-05,NDC,,,facility,both,1,EA,,548.76,548.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50),636,RC,13533-318-05,NDC,,,facility,both,1,EA,,418.38,418.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-318-10,NDC,,,facility,both,1,EA,,448.37,448.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-318-10,NDC,,,facility,both,1,EA,,422.33,422.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-318-50,NDC,,,facility,both,1,EA,,615.41,615.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-318-50,NDC,,,facility,both,1,EA,,428.06,428.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hypertet: 1 Syringe, Glass In 1 Box (13533-634-02)  / 1 Ml In 1 Syringe, Glass (13533-634-20)",636,RC,13533-634-02,NDC,,,facility,both,1,EA,,1029.98,1029.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hypertet: 1 Syringe, Glass In 1 Box (13533-634-02)  / 1 Ml In 1 Syringe, Glass (13533-634-20)",636,RC,13533-634-02,NDC,,,facility,both,1,EA,,1022.1,1022.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,13533-634-20,NDC,,,facility,both,1,EA,,964.3,964.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,68.05,68.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-6623-61)  / 1 Capsule In 1 Blister Pack,636,RC,0904-6623-61,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-6624-61)  / 1 Capsule In 1 Blister Pack,636,RC,0904-6624-61,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-6624-61)  / 1 Capsule In 1 Blister Pack,636,RC,0904-6624-61,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 100 Blister Pack In 1 Carton (0904-6552-61)  / 1 Tablet, Film Coated In 1 Blister Pack",636,RC,0904-6552-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Banophen: 100 Capsule In 1 Bottle (0904-5307-60),636,RC,0904-5307-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-2056-61)  / 10 Capsule In 1 Blister Pack,636,RC,0904-2056-61,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dronabinol: 100 Blister Pack In 1 Carton (0904-7144-61)  / 1 Capsule In 1 Blister Pack,636,RC,0904-7144-61,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7130-61)  / 1 Tablet, Film Coated In 1 Blister Pack",636,RC,0904-7130-61,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-7097-61)  / 1 Capsule In 1 Blister Pack,636,RC,0904-7097-61,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Blister Pack In 1 Carton (0904-7097-61)  / 1 Capsule In 1 Blister Pack,636,RC,0904-7097-61,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine hydrochloride: 10 TRAY in 1 CASE (0904-6740-70)  / 10 CUP, UNIT-DOSE in 1 TRAY / 5 mL in 1 CUP, UNIT-DOSE",636,RC,0904-6740-70,NDC,,,facility,both,1,EA,,7.36,7.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61)  / 1 Tablet In 1 Blister Pack,636,RC,0904-6923-61,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61)  / 1 Tablet In 1 Blister Pack,636,RC,0904-6923-61,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-907-11,NDC,,,facility,both,1,EA,,5.36,5.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-907-11,NDC,,,facility,both,1,EA,,5.36,5.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-918-95,NDC,,,facility,both,1,EA,,5.35,5.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phentolamine Mesylate: 1 Vial In 1 Carton (68094-101-20)  / 1 Injection In 1 Vial,636,RC,68094-101-20,NDC,,,facility,both,1,EA,,543.19,543.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phentolamine Mesylate: 1 Vial In 1 Carton (68094-101-20)  / 1 Injection In 1 Vial,636,RC,68094-101-20,NDC,,,facility,both,1,EA,,567.6,567.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-229-11,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-221-11,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-149-11,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-149-11,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-155-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-450-11,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68084-450-11,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,69097-168-48,NDC,,,facility,both,1,EA,,3.6,3.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,69097-318-32,NDC,,,facility,both,1,EA,,6.08,6.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,69097-708-31,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3075-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3075-3,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,69097-708-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 10 Vial In 1 Carton (69097-708-96)  / 1 Ml In 1 Vial,636,RC,69097-708-96,NDC,,,facility,both,1,EA,,2.64,2.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3040-3,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3040-3,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Posaconazole: 1 Vial In 1 Carton (68462-904-01)  / 16.7 Ml In 1 Vial,636,RC,68462-904-01,NDC,,,facility,both,1,EA,,177.33,177.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Alphanate: 1 Kit In 1 Carton (68516-4617-1)  *  5 Ml In 1 Vial (68516-4606-1)  *  5 Ml In 1 Vial, Glass (76297-002-02)",636,RC,68516-4617-1,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Alphanate: 1 Kit In 1 Carton (68516-4618-2)  *  10 Ml In 1 Vial (68516-4607-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)",636,RC,68516-4618-2,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68516-5216-7,NDC,,,facility,both,1,EA,,78.5,78.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68516-5216-7,NDC,,,facility,both,1,EA,,78.5,78.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68516-5218-0,NDC,,,facility,both,1,EA,,29.31,29.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68516-5218-0,NDC,,,facility,both,1,EA,,28.15,28.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Yutiq: 1 Pouch In 1 Carton (68611-180-01)  / 1 Applicator In 1 Pouch / 1 Implant In 1 Applicator,636,RC,68611-180-01,NDC,,,facility,both,1,EA,,1001.72,1001.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Yutiq: 1 Pouch In 1 Carton (68611-180-01)  / 1 Applicator In 1 Pouch / 1 Implant In 1 Applicator,636,RC,68611-180-01,NDC,,,facility,both,1,EA,,1009.18,1009.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Iluvien: 1 Tray In 1 Carton (68611-190-02)  / 1 Applicator In 1 Tray / 1 Implant In 1 Applicator,636,RC,68611-190-02,NDC,,,facility,both,1,EA,,949.57,949.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Iluvien: 1 Tray In 1 Carton (68611-190-02)  / 1 Applicator In 1 Tray / 1 Implant In 1 Applicator,636,RC,68611-190-02,NDC,,,facility,both,1,EA,,949.57,949.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)",636,RC,68727-712-01,NDC,,,facility,both,1,EA,,393.47,393.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)",636,RC,68727-712-01,NDC,,,facility,both,1,EA,,393.47,393.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Abraxane: 1 Vial, Single-Use In 1 Carton (68817-134-50)  / 20 Ml In 1 Vial, Single-Use",636,RC,68817-134-50,NDC,,,facility,both,1,EA,,28.56,28.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3010-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3010-3,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3010-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3010-3,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Octreotide Acetate: 10 Vial In 1 Carton (68462-897-10)  / 1 Ml In 1 Vial (68462-897-01),636,RC,68462-897-10,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,69339-136-03,NDC,,,facility,both,1,EA,,10.61,10.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68462-897-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68462-897-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sirolimus: 100 Tablet, Film Coated In 1 Bottle (68382-520-01)",636,RC,68382-520-01,NDC,,,facility,both,1,EA,,12.89,12.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sirolimus: 100 Tablet, Film Coated In 1 Bottle (68382-520-01)",636,RC,68382-520-01,NDC,,,facility,both,1,EA,,12.9,12.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Perphenazine: 100 Tablet In 1 Bottle (68382-591-01),636,RC,68382-591-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68382-860-02,NDC,,,facility,both,1,EA,,20.63,20.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68382-910-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68462-469-40,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68462-469-40,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bumetanide: 10 Vial, Single-Dose In 1 Carton (68462-469-54)  / 4 Ml In 1 Vial, Single-Dose (68462-469-40)",636,RC,68462-469-54,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Epinephrine: 1 Vial, Multi-Dose In 1 Carton (68462-760-10)  / 10 Ml In 1 Vial, Multi-Dose",636,RC,68462-760-10,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylprednisolone: 25 Tablet In 1 Bottle (68382-917-11),636,RC,68382-917-11,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylprednisolone: 25 Tablet In 1 Bottle (68382-917-11),636,RC,68382-917-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (68462-105-30)",636,RC,68462-105-30,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,68462-157-40,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,55.94,55.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,57.02,57.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-293-00,NDC,,,facility,both,1,EA,,6.43,6.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desmopressin Acetate: 10 Vial, Single-Dose In 1 Carton (65219-293-01)  / 1 Ml In 1 Vial, Single-Dose (65219-293-00)",636,RC,65219-293-01,NDC,,,facility,both,1,EA,,6.38,6.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-436-02,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-445-01,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-472-05,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-479-05,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-572-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-572-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-635-00,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 25 Ampule In 1 Carton (65282-1605-1)  / 5 Ml In 1 Ampule,636,RC,65282-1605-1,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,57.78,57.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,57.52,57.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,58.62,58.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,55.66,55.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,65862-390-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,65862-390-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-188-30)",636,RC,65862-188-30,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-224-01,NDC,,,facility,both,1,EA,,6.84,6.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-222-01,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,64875-001-01,NDC,,,facility,both,1,EA,,84.28,84.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Byooviz: 1 Vial, Single-Dose In 1 Carton (64406-019-01)  / .05 Ml In 1 Vial, Single-Dose (64406-019-07)",636,RC,64406-019-01,NDC,,,facility,both,1,EA,,454.98,454.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,64679-012-02,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,56.62,56.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,60.84,60.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,58.04,58.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,60.83,60.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-162-01,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,65219-220-01,NDC,,,facility,both,1,EA,,5.55,5.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ondansetron: 50 Ml In 1 Bottle (65162-691-79),636,RC,65162-691-79,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Eptifibatide: 1 Vial In 1 Carton (67457-631-10)  / 100 Ml In 1 Vial,636,RC,67457-631-10,NDC,,,facility,both,1,EA,,7.4,7.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-638-00,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-639-00,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-639-00,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Miacalcin: 1 Vial, Multi-Dose In 1 Carton (67457-675-02)  / 2 Ml In 1 Vial, Multi-Dose",636,RC,67457-675-02,NDC,,,facility,both,1,EA,,841.11,841.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-778-00,NDC,,,facility,both,1,EA,,21.87,21.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-815-00,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Eptifibatide: 1 Vial In 1 Carton (67457-629-10)  / 10 Ml In 1 Vial,636,RC,67457-629-10,NDC,,,facility,both,1,EA,,6.64,6.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 1 Vial In 1 Carton (67457-853-50)  / 5 Ml In 1 Vial,636,RC,67457-853-50,NDC,,,facility,both,1,EA,,48.43,48.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-855-00,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adenosine: 10 Vial, Single-Dose In 1 Carton (67457-855-02)  / 2 Ml In 1 Vial, Single-Dose (67457-855-00)",636,RC,67457-855-02,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-887-00,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 25 Vial In 1 Carton (67457-887-01)  / 1 Ml In 1 Vial (67457-887-00),636,RC,67457-887-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-585-00,NDC,,,facility,both,1,EA,,5.29,5.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-584-00,NDC,,,facility,both,1,EA,,5.45,5.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-422-00,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-422-54)  / 5 Ml In 1 Vial (67457-422-00),636,RC,67457-422-54,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-426-00,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-426-00,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-433-00,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-437-00,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-438-00,NDC,,,facility,both,1,EA,,18.63,18.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vecuronium Bromide: 10 Vial In 1 Carton (67457-438-10)  / 10 Ml In 1 Vial (67457-438-00),636,RC,67457-438-10,NDC,,,facility,both,1,EA,,122.73,122.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-440-00,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron Hydrochloride: 25 VIAL, SINGLE-DOSE in 1 CARTON (67457-440-22)  / 2 mL in 1 VIAL, SINGLE-DOSE (67457-440-00) ",636,RC,67457-440-22,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron Hydrochloride: 1 VIAL, MULTI-DOSE in 1 CARTON (67457-441-20)  / 20 mL in 1 VIAL, MULTI-DOSE",636,RC,67457-441-20,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pamidronate Disodium: 1 Vial In 1 Carton (67457-446-10)  / 10 Ml In 1 Vial,636,RC,67457-446-10,NDC,,,facility,both,1,EA,,16.9,16.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pamidronate Disodium: 1 Vial In 1 Carton (67457-446-10)  / 10 Ml In 1 Vial,636,RC,67457-446-10,NDC,,,facility,both,1,EA,,16.9,16.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-475-00,NDC,,,facility,both,1,EA,,103,103,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67877-718-33,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67877-721-33,NDC,,,facility,both,1,EA,,9.23,9.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67877-721-33,NDC,,,facility,both,1,EA,,9.23,9.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dronabinol: 60 Capsule In 1 Bottle (67877-753-60),636,RC,67877-753-60,NDC,,,facility,both,1,EA,,3.39,3.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,67919-030-01,NDC,,,facility,both,1,EA,,15.75,15.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,67919-030-01,NDC,,,facility,both,1,EA,,15.27,15.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,67919-030-01,NDC,,,facility,both,1,EA,,14.34,14.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Everolimus: 6 Blister Pack In 1 Carton (67877-718-31)  / 10 Tablet In 1 Blister Pack (67877-718-33),636,RC,67877-718-31,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (67877-230-22)  / 225 Ml In 1 Bottle, Plastic",636,RC,67877-230-22,NDC,,,facility,both,1,EA,,5.86,5.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (67877-230-22)  / 225 Ml In 1 Bottle, Plastic",636,RC,67877-230-22,NDC,,,facility,both,1,EA,,6.4,6.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Azathioprine: 100 Tablet In 1 Bottle (67877-493-01),636,RC,67877-493-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-422-00,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-374-12,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (66689-307-08)  / 250 Ml In 1 Bottle, Plastic",636,RC,66689-307-08,NDC,,,facility,both,1,EA,,6.39,6.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (66689-307-08)  / 250 Ml In 1 Bottle, Plastic",636,RC,66689-307-08,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23)  / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,152.87,152.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amiodarone Hydrochloride: 1 Vial, Glass In 1 Carton (67457-153-18)  / 18 Ml In 1 Vial, Glass",636,RC,67457-153-18,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-182-00,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-196-00,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (67457-217-20)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,67457-217-20,NDC,,,facility,both,1,EA,,36.82,36.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-227-00,NDC,,,facility,both,1,EA,,12.23,12.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-228-00,NDC,,,facility,both,1,EA,,5.26,5.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-266-00,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-299-00,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Moxifloxacin Hydrochloride: 1 Bag In 1 Carton (67457-323-25)  / 250 Ml In 1 Bag,636,RC,67457-323-25,NDC,,,facility,both,1,EA,,19.91,19.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 10 Vial In 1 Carton (67457-340-01)  / 20 Ml In 1 Vial (67457-340-00),636,RC,67457-340-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-374-12,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,67457-153-00,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23)  / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,152.87,152.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 10 VIAL, SINGLE-DOSE in 1 CARTON (66794-210-41)  / 2 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE (66794-210-02) ",636,RC,66794-210-41,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,66794-219-63,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,66794-219-63,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,66993-490-84,NDC,,,facility,both,1,EA,,356.94,356.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)",636,RC,67066-005-01,NDC,,,facility,both,1,EA,,78.72,78.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)",636,RC,67066-005-01,NDC,,,facility,both,1,EA,,80.21,80.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)",636,RC,67066-005-01,NDC,,,facility,both,1,EA,,80.25,80.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vyepti: 1 Vial, Single-Dose In 1 Carton (67386-130-51)  / 1 Ml In 1 Vial, Single-Dose",636,RC,67386-130-51,NDC,,,facility,both,1,EA,,37.43,37.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vyepti: 1 Vial, Single-Dose In 1 Carton (67386-130-51)  / 1 Ml In 1 Vial, Single-Dose",636,RC,67386-130-51,NDC,,,facility,both,1,EA,,36.22,36.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vyepti: 1 Vial, Single-Dose In 1 Carton (67386-130-51)  / 1 Ml In 1 Vial, Single-Dose",636,RC,67386-130-51,NDC,,,facility,both,1,EA,,37.54,37.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vyepti: 1 Vial, Single-Dose In 1 Carton (67386-130-51)  / 1 Ml In 1 Vial, Single-Dose",636,RC,67386-130-51,NDC,,,facility,both,1,EA,,36.27,36.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-152-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-152-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Mg In 1 Bottle (72603-212-01),636,RC,72603-212-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (72603-220-01)",636,RC,72603-220-01,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-221-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-139-01,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-251-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 4 Vial In 1 Carton (72485-415-04)  / 20 Ml In 1 Vial,636,RC,72485-415-04,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-416-01,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-417-01,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-422-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-507-01,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-507-01,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Thiamine: 25 Vial, Multi-Dose In 1 Carton (72485-507-25)  / 2 Ml In 1 Vial, Multi-Dose (72485-507-01)",636,RC,72485-507-25,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72512-920-00,NDC,,,facility,both,1,EA,,1773.51,1773.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Qutenza: 1 Kit In 1 Carton (72512-928-01)  *  1 Pouch In 1 Carton (72512-920-00)  / 1 Patch In 1 Pouch / 179 Mg In 1 Patch *  50 G In 1 Tube,636,RC,72512-928-01,NDC,,,facility,both,1,EA,,1780.54,1780.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Qutenza: 1 Kit In 1 Carton (72512-928-01)  *  1 Pouch In 1 Carton (72512-920-00)  / 1 Patch In 1 Pouch / 179 Mg In 1 Patch *  50 G In 1 Tube,636,RC,72512-928-01,NDC,,,facility,both,1,EA,,1744.29,1744.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-415-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (72603-325-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-325-01,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73043-023-91,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73043-023-91,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73043-023-91,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass",636,RC,73070-100-11,NDC,,,facility,both,1,EA,,3.37,3.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-474-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-474-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72603-474-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72611-719-01,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72611-722-01,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (72603-325-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-325-01,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-404-01,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72485-403-01,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yutiq: 1 Pouch In 1 Box, Unit-Dose (71879-136-01)  / 1 Applicator In 1 Pouch / 1 Implant In 1 Applicator",636,RC,71879-136-01,NDC,,,facility,both,1,EA,,979.56,979.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yutiq: 1 Pouch In 1 Box, Unit-Dose (71879-136-01)  / 1 Applicator In 1 Pouch / 1 Implant In 1 Applicator",636,RC,71879-136-01,NDC,,,facility,both,1,EA,,994.26,994.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72196-6074-1,NDC,,,facility,both,1,EA,,12.74,12.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71506-028-59,NDC,,,facility,both,1,EA,,998.29,998.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-719-10,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (71288-721-11)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-721-11,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-737-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-803-20,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71390-011-00,NDC,,,facility,both,1,EA,,3.88,3.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71390-011-00,NDC,,,facility,both,1,EA,,3.83,3.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1027-1),636,RC,71399-1027-1,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1027-1),636,RC,71399-1027-1,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1028-1),636,RC,71399-1028-1,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71449-091-43,NDC,,,facility,both,1,EA,,10.86,10.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71449-091-43,NDC,,,facility,both,1,EA,,10.86,10.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71449-091-90,NDC,,,facility,both,1,EA,,62.81,62.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71506-016-59,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72205-101-01,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72205-101-01,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72205-102-01,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01)  / 100 Ml In 1 Bag,636,RC,72266-152-01,NDC,,,facility,both,1,EA,,7.59,7.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01)  / 100 Ml In 1 Bag,636,RC,72266-152-01,NDC,,,facility,both,1,EA,,7.58,7.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-160-01,NDC,,,facility,both,1,EA,,11,11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-204-01,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-234-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-234-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-234-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-234-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-234-25)  / 1 Ml In 1 Vial (72266-234-01),636,RC,72266-234-25,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-237-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Caffeine Citrate: 1 Vial, Glass In 1 Carton (72485-104-01)  / 3 Ml In 1 Vial, Glass",636,RC,72485-104-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-147-01,NDC,,,facility,both,1,EA,,6.71,6.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01)  / 20 Ml In 1 Vial, Single-Dose",636,RC,72266-131-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01)  / 20 Ml In 1 Vial, Single-Dose",636,RC,72266-131-01,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72205-102-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72205-102-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-102-01)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,72266-102-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,72266-127-01,NDC,,,facility,both,1,EA,,8.52,8.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-716-11,NDC,,,facility,both,1,EA,,8.23,8.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-420-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,73090-420-01,NDC,,,facility,both,1,EA,,308.89,308.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-2363-1,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-2364-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propofol: 20 Vial In 1 Carton (80830-2364-8)  / 50 Ml In 1 Vial (80830-2364-1),636,RC,80830-2364-8,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-2365-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-2362-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,81284-152-00,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,81284-211-00,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,81284-315-00,NDC,,,facility,both,1,EA,,15.36,15.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,81284-315-00,NDC,,,facility,both,1,EA,,15.36,15.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,81284-411-00,NDC,,,facility,both,1,EA,,42.48,42.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-2362-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Celestone Soluspan: 1 Vial, Multi-Dose In 1 Box (78206-118-01)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,78206-118-01,NDC,,,facility,both,1,EA,,10.39,10.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,74.31,74.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,71.89,71.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,73.37,73.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,71.89,71.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,72.14,72.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,71.89,71.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,73.64,73.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,71.89,71.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-1188-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,80830-1188-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,9999-1017-48,NDC,,,facility,both,1,EA,,686.42,686.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,99999-1011-09,NDC,,,facility,both,1,EA,,16.99,16.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,9999-1009-42,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,9999-0601-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Izervay: 1 Vial, Single-Dose In 1 Carton (82829-002-01)  / .35 Ml In 1 Vial, Single-Dose",636,RC,82829-002-01,NDC,,,facility,both,1,EA,,205.65,205.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,83090-011-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,83090-011-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,83090-011-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ogivri: 1 Vial In 1 Carton (83257-001-11)  / 15 Ml In 1 Vial,636,RC,83257-001-11,NDC,,,facility,both,1,EA,,81.72,81.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ogivri: 1 Vial In 1 Carton (83257-001-11)  / 15 Ml In 1 Vial,636,RC,83257-001-11,NDC,,,facility,both,1,EA,,73.29,73.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ogivri: 1 Vial In 1 Carton (83257-001-11)  / 15 Ml In 1 Vial,636,RC,83257-001-11,NDC,,,facility,both,1,EA,,73.29,73.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,83257-003-11,NDC,,,facility,both,1,EA,,107.63,107.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ogivri: 1 Kit In 1 Carton (83257-004-12)  *  20 Ml In 1 Vial, Multi-Dose (83257-003-11)  *  20 Ml In 1 Vial (83257-002-11)",636,RC,83257-004-12,NDC,,,facility,both,1,EA,,86.05,86.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,252.27,252.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,252.27,252.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,243.07,243.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bivalirudin: 10 Vial, Single-Dose In 1 Carton (83634-400-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (83634-400-41)",636,RC,83634-400-10,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,83634-400-41,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-004-01,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76045-204-00,NDC,,,facility,both,1,EA,,11.65,11.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide: 30 Pouch In 1 Carton (76204-100-01)  / 1 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule,636,RC,76204-100-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-421-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,73090-421-01,NDC,,,facility,both,1,EA,,302.22,302.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-421-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,73090-421-01,NDC,,,facility,both,1,EA,,304.45,304.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73177-116-02,NDC,,,facility,both,1,EA,,5.16,5.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73177-146-33,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73177-163-33,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,73293-0001-1,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide: 30 Pouch In 1 Carton (76204-100-01)  / 1 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule,636,RC,76204-100-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-200-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-200-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naloxone Hydrochloride: 10 Syringe In 1 Box (76329-3369-1)  / 2 Ml In 1 Syringe,636,RC,76329-3369-1,NDC,,,facility,both,1,EA,,18.94,18.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naloxone Hydrochloride: 10 Syringe In 1 Box (76329-3369-1)  / 2 Ml In 1 Syringe,636,RC,76329-3369-1,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 10 Syringe In 1 Package (76329-3390-1)  / 5 Ml In 1 Syringe,636,RC,76329-3390-1,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,76329-8261-0,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 1 Vial In 1 Carton (76329-9060-0)  / 30 Ml In 1 Vial,636,RC,76329-9060-0,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-200-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-600-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-600-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Syringe In 1 Carton (76329-1240-1)  / .5 Ml In 1 Syringe,636,RC,76329-1240-1,NDC,,,facility,both,1,EA,,42.7,42.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose Monohydrate: 1 Syringe In 1 Carton (76329-3302-1)  / 50 Ml In 1 Syringe,636,RC,76329-3302-1,NDC,,,facility,both,1,EA,,15.88,15.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose Monohydrate: 1 Syringe In 1 Carton (76329-3302-1)  / 50 Ml In 1 Syringe,636,RC,76329-3302-1,NDC,,,facility,both,1,EA,,22.57,22.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Chloride: 10 Syringe In 1 Package (76329-3304-1)  / 10 Ml In 1 Syringe,636,RC,76329-3304-1,NDC,,,facility,both,1,EA,,18.65,18.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 10 VIAL in 1 PACKAGE (76329-3316-1)  / 10 mL in 1 VIAL,636,RC,76329-3316-1,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 10 Carton In 1 Package (76329-3318-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3318-1,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 10 Carton In 1 Package (76329-3318-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3318-1,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1552-07,NDC,,,facility,both,1,EA,,13.07,13.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1622-03,NDC,,,facility,both,1,EA,,6.3,6.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-9053-05,NDC,,,facility,both,1,EA,,15.93,15.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-9053-05,NDC,,,facility,both,1,EA,,15.99,15.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-9054-05,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Udenyca: 1 Syringe In 1 Carton (70114-130-01)  / .6 Ml In 1 Syringe,636,RC,70114-130-01,NDC,,,facility,both,1,EA,,460.95,460.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70121-1049-1,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Triamcinolone Acetonide: 1 Vial, Multi-Dose In 1 Carton (70121-1168-1)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,70121-1168-1,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Docetaxel: 1 Vial, Glass In 1 Carton (70121-1222-1)  / 4 Ml In 1 Vial, Glass",636,RC,70121-1222-1,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70121-1453-1,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70095-025-01,NDC,,,facility,both,1,EA,,6.23,6.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1475-50,NDC,,,facility,both,1,EA,,12.03,12.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1005-38,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1030-36,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1046-46,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1046-46,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1046-46,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1068-07,NDC,,,facility,both,1,EA,,13.33,13.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1086-44,NDC,,,facility,both,1,EA,,7.42,7.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1094-36,NDC,,,facility,both,1,EA,,11,11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70092-1418-36,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70512-842-01,NDC,,,facility,both,1,EA,,2.69,2.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70512-842-01,NDC,,,facility,both,1,EA,,2.69,2.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70512-843-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70512-843-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allergy Relief: 1 Bottle, Plastic In 1 Carton (70677-1015-2)  / 100 Capsule In 1 Bottle, Plastic",636,RC,70677-1015-2,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ganciclovir: 25 Vial In 1 Carton (70436-089-55)  / 10 Ml In 1 Vial,636,RC,70436-089-55,NDC,,,facility,both,1,EA,,24.52,24.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylprednisolone Acetate: 1 Vial, Single-Dose In 1 Carton (70121-1573-1)  / 1 Ml In 1 Vial, Single-Dose",636,RC,70121-1573-1,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70121-1647-1,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70121-1647-1,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70121-1720-1,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lioresal (Baclofen): 2 Ampule In 1 Box (70121-2505-2)  / 1 Kit In 1 Ampule,636,RC,70121-2505-2,NDC,,,facility,both,1,EA,,283.5,283.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lioresal (Baclofen): 2 Ampule In 1 Box (70121-2505-2)  / 1 Kit In 1 Ampule,636,RC,70121-2505-2,NDC,,,facility,both,1,EA,,284.2,284.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70257-563-20,NDC,,,facility,both,1,EA,,262.06,262.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Promethazine Hydrochloride: 473 Ml In 1 Bottle (70408-146-34),636,RC,70408-146-34,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Azithromycin: 10 Vial In 1 Box (70436-019-82)  / 5 Ml In 1 Vial,636,RC,70436-019-82,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 10 Vial In 1 Carton (70436-021-82)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,70436-021-82,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Acetate: 50 Ml In 1 Vial, Pharmacy Bulk Package (69784-230-10)",636,RC,69784-230-10,NDC,,,facility,both,1,EA,,42.36,42.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Acetate: 100 Ml In 1 Vial, Pharmacy Bulk Package (69784-231-10)",636,RC,69784-231-10,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nabi-Hb: 1 Vial, Single-Use In 1 Carton (69800-4202-1)  / 1 Ml In 1 Vial, Single-Use (69800-4202-2)",636,RC,69800-4202-1,NDC,,,facility,both,1,EA,,163.4,163.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Andexxa: 4 Vial, Single-Use In 1 Carton (69853-0102-1)  / 20 Ml In 1 Vial, Single-Use",636,RC,69853-0102-1,NDC,,,facility,both,1,EA,,238.17,238.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01),636,RC,69918-899-01,NDC,,,facility,both,1,EA,,9.71,9.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01),636,RC,69918-899-01,NDC,,,facility,both,1,EA,,10.37,10.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,69452-350-60,NDC,,,facility,both,1,EA,,4.34,4.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70004-923-59,NDC,,,facility,both,1,EA,,29.56,29.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70069-019-01,NDC,,,facility,both,1,EA,,6.53,6.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70069-021-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70069-021-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ropivacaine Hydrochloride: 1 Vial In 1 Carton (70069-064-01)  / 30 Ml In 1 Vial,636,RC,70069-064-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70069-101-01,NDC,,,facility,both,1,EA,,7.63,7.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70069-101-01,NDC,,,facility,both,1,EA,,8.57,8.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70069-361-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70004-923-59,NDC,,,facility,both,1,EA,,29.56,29.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70004-924-44,NDC,,,facility,both,1,EA,,37.24,37.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70004-926-44,NDC,,,facility,both,1,EA,,32.1,32.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70004-928-44,NDC,,,facility,both,1,EA,,37.49,37.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-716-11,NDC,,,facility,both,1,EA,,3.6,3.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-028-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-113-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-113-10,NDC,,,facility,both,1,EA,,5.51,5.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-113-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-113-10,NDC,,,facility,both,1,EA,,6.96,6.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-114-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-114-50,NDC,,,facility,both,1,EA,,5.55,5.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-114-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-114-50,NDC,,,facility,both,1,EA,,5.35,5.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50)  / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50)  / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel Protein-Bound Particles For Injectable Suspension (Albumin-Bound): 1 Vial, Single-Use In 1 Carton (71288-183-50)  / 20 Ml In 1 Vial, Single-Use",636,RC,71288-183-50,NDC,,,facility,both,1,EA,,24.91,24.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Regadenoson: 1 Syringe, Plastic In 1 Carton (71288-201-85)  / 5 Ml In 1 Syringe, Plastic",636,RC,71288-201-85,NDC,,,facility,both,1,EA,,2.91,2.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Regadenoson: 1 Syringe, Plastic In 1 Carton (71288-201-85)  / 5 Ml In 1 Syringe, Plastic",636,RC,71288-201-85,NDC,,,facility,both,1,EA,,5.51,5.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50)  / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71266-2001-2,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71266-5040-1,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71266-5083-1,NDC,,,facility,both,1,EA,,11.25,11.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71266-5100-1,NDC,,,facility,both,1,EA,,10.09,10.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71266-5103-1,NDC,,,facility,both,1,EA,,10.07,10.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71266-8006-1,NDC,,,facility,both,1,EA,,126.44,126.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71285-6064-1,NDC,,,facility,both,1,EA,,14.85,14.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71285-6074-1,NDC,,,facility,both,1,EA,,8.98,8.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71285-6074-1,NDC,,,facility,both,1,EA,,8.99,8.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-009-21,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-433-82,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-433-82,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-434-84,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-434-84,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-435-86,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-432-80,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-435-86,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-436-88,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-437-91,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-438-93,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-600-10,NDC,,,facility,both,1,EA,,1.98,1.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-600-10,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-436-88,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-432-80,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-303-01,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-303-01,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-402-10,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-402-10,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (71288-402-11)  / 10 Ml In 1 Vial, Multi-Dose (71288-402-10)",636,RC,71288-402-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-403-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Palonosetron Hydrochloride: 1 Vial, Single-Dose In 1 Carton (71288-409-05)  / 5 Ml In 1 Vial, Single-Dose",636,RC,71288-409-05,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-411-80,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Enoxaparin Sodium: 1 Vial, Multi-Dose In 1 Carton (71288-426-03)  / 3 Ml In 1 Vial, Multi-Dose",636,RC,71288-426-03,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-427-10,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,71288-203-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1)  / 10 Ml In 1 Vial, Single-Dose",636,RC,70710-1530-1,NDC,,,facility,both,1,EA,,90.28,90.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Micafungin: 1 Vial In 1 Carton (70710-1724-1)  / 5 Ml In 1 Vial,636,RC,70710-1724-1,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Micafungin: 1 Vial In 1 Carton (70710-1725-1)  / 5 Ml In 1 Vial,636,RC,70710-1725-1,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70710-1838-1,NDC,,,facility,both,1,EA,,2.78,2.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70710-1838-1,NDC,,,facility,both,1,EA,,2.74,2.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70710-1838-1,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Haloperidol Decanoate: 1 Vial, Single-Dose In 1 Carton (70710-1463-1)  / 1 Ml In 1 Vial, Single-Dose",636,RC,70710-1463-1,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylene Blue: 5 Vial In 1 Carton (70710-1838-5)  / 10 Ml In 1 Vial (70710-1838-1),636,RC,70710-1838-5,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoladex: 1 Pouch In 1 Carton (70720-951-30)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-951-30,NDC,,,facility,both,1,EA,,1727.71,1727.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoladex: 1 Pouch In 1 Carton (70720-951-30)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-951-30,NDC,,,facility,both,1,EA,,1851.14,1851.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70748-323-02,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Haloperidol Decanoate: 1 Vial, Single-Dose In 1 Carton (70710-1463-1)  / 1 Ml In 1 Vial, Single-Dose",636,RC,70710-1463-1,NDC,,,facility,both,1,EA,,13.28,13.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70710-1359-1,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70700-167-22,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70700-167-22,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tobramycin: 1 Vial, Pharmacy Bulk Package In 1 Carton (70700-173-22)  / 50 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,70700-173-22,NDC,,,facility,both,1,EA,,6.26,6.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (70700-189-22)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,70700-189-22,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (70700-189-22)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,70700-189-22,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 1 Ml In 1 Container (70700-315-22),636,RC,70700-315-22,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 1 Vial In 1 Carton (70700-315-27)  / 1 Ml In 1 Vial,636,RC,70700-315-27,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70748-323-02,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70748-323-02,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Promethazine Hydrochloride: 473 Ml In 1 Bottle, Plastic (70752-138-12)",636,RC,70752-138-12,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70860-701-41,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70860-778-41,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 473 Ml In 1 Bottle (70954-188-10),636,RC,70954-188-10,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70860-126-41,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70756-604-44,NDC,,,facility,both,1,EA,,8.2,8.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tobramycin: 14 Pouch In 1 Carton (70756-604-56)  / 4 Ampule In 1 Pouch (70756-604-44)  / 5 Ml In 1 Ampule,636,RC,70756-604-56,NDC,,,facility,both,1,EA,,8.56,8.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70756-612-12,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70756-612-12,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol Decanoate: 1 Vial In 1 Carton (70756-615-81)  / 1 Ml In 1 Vial,636,RC,70756-615-81,NDC,,,facility,both,1,EA,,9.01,9.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70842-120-01,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 10 Vial, Single-Dose In 1 Carton (70860-100-10)  / 5 Ml In 1 Vial, Single-Dose (70860-100-41)",636,RC,70860-100-10,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,70860-100-41,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,59923-615-01,NDC,,,facility,both,1,EA,,9.32,9.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"PROMETHAZINE HYDROCHLORIDE: 473 mL in 1 BOTTLE, PLASTIC (60432-608-16) ",636,RC,60432-608-16,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sirolimus: 100 Tablet, Sugar Coated In 1 Bottle (59762-1001-1)",636,RC,59762-1001-1,NDC,,,facility,both,1,EA,,12.6,12.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Azithromycin: 1 Bottle In 1 Carton (59762-3140-1)  / 30 Ml In 1 Bottle,636,RC,59762-3140-1,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1)  / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 VIAL, SINGLE-DOSE in 1 CARTON (60505-0749-5)  / 3 mL in 1 VIAL, SINGLE-DOSE",636,RC,60505-0749-5,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone: 10 VIAL in 1 CARTON (60505-0753-4)  / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL",636,RC,60505-0753-4,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylprednisolone: 25 Tablet In 1 Bottle (59762-0049-1),636,RC,59762-0049-1,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,80.04,80.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,79.27,79.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,59630-266-01,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,59630-266-01,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fetroja: 10 Vial, Single-Use In 1 Carton (59630-266-10)  / 10 Ml In 1 Vial, Single-Use (59630-266-01)",636,RC,59630-266-10,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,59385-023-01,NDC,,,facility,both,1,EA,,21.14,21.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Abilify Maintena: 1 Kit In 1 Carton (59148-045-80)  *  1.5 Ml In 1 Syringe *  5 Ml In 1 Syringe,636,RC,59148-045-80,NDC,,,facility,both,1,EA,,12.6,12.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Abilify Maintena: 1 Kit In 1 Carton (59148-045-80)  *  1.5 Ml In 1 Syringe *  5 Ml In 1 Syringe,636,RC,59148-045-80,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Abilify Maintena: 1 Kit In 1 Carton (59148-072-80)  *  1.9 Ml In 1 Syringe *  5 Ml In 1 Syringe,636,RC,59148-072-80,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Feraheme: 1 Vial, Single-Use In 1 Carton (59338-775-01)  / 17 Ml In 1 Vial, Single-Use",636,RC,59338-775-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Feraheme: 1 Vial, Single-Use In 1 Carton (59338-775-01)  / 17 Ml In 1 Vial, Single-Use",636,RC,59338-775-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paragard T 380A: 1 Pouch In 1 Carton (59365-5128-1)  / 1 Intrauterine Device In 1 Pouch,636,RC,59365-5128-1,NDC,,,facility,both,1,EA,,2122.44,2122.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Paragard T 380A: 1 Pouch In 1 Carton (59365-5129-1)  / 1 Intrauterine Device In 1 Pouch,636,RC,59365-5129-1,NDC,,,facility,both,1,EA,,2232.44,2232.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,59385-023-01,NDC,,,facility,both,1,EA,,21.37,21.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-113-06),636,RC,59746-113-06,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-113-06),636,RC,59746-113-06,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-115-06),636,RC,59746-115-06,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-115-06),636,RC,59746-115-06,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-172-06),636,RC,59746-172-06,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-172-06),636,RC,59746-172-06,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-173-06),636,RC,59746-173-06,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-173-06),636,RC,59746-173-06,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-175-06),636,RC,59746-175-06,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-175-06),636,RC,59746-175-06,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59746-782-01),636,RC,59746-782-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1)  / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-484-01),636,RC,59651-484-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-484-01),636,RC,59651-484-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-485-01),636,RC,59651-485-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-485-01),636,RC,59651-485-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-489-01),636,RC,59651-489-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 100 Tablet In 1 Bottle (59651-489-01),636,RC,59651-489-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1)  / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-394-79,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-395-79,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-375-11,NDC,,,facility,both,1,EA,,12.79,12.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-375-11,NDC,,,facility,both,1,EA,,12.79,12.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-492-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-481-11,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 Vial, Single-Dose In 1 Carton (60505-6231-5)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (60505-6231-0)",636,RC,60505-6231-5,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60505-6159-0,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60505-6157-0,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 25 Vial, Single-Use In 1 Carton (60505-6130-5)  / 2 Ml In 1 Vial, Single-Use (60505-6130-0)",636,RC,60505-6130-5,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6)  / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6)  / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6)  / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60505-6142-0,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 Vial, Single-Dose In 1 Carton (60505-6142-5)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (60505-6142-0)",636,RC,60505-6142-5,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,60505-6146-0,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,60505-6146-0,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,60505-6147-0,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,60505-6147-0,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (60505-6148-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use",636,RC,60505-6148-0,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (60505-6148-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use",636,RC,60505-6148-0,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60505-6149-0,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (60505-6151-4)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use",636,RC,60505-6151-4,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60505-6156-0,NDC,,,facility,both,1,EA,,2.38,2.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-122-11,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-122-11,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-134-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-134-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-145-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-145-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esmolol Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-194-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-194-10,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-202-00,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-202-00,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (55150-207-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-207-20,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (55150-207-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-207-20,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (55150-208-30)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-208-30,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Meropenem: 10 Vial In 1 Carton (55150-208-30)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-208-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (55150-218-99)  / 100 Ml In 1 Vial, Single-Dose",636,RC,55150-218-99,NDC,,,facility,both,1,EA,,8.08,8.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (55150-219-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-219-10,NDC,,,facility,both,1,EA,,10.19,10.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (55150-219-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-219-10,NDC,,,facility,both,1,EA,,8.82,8.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etomidate: 10 Vial, Single-Dose In 1 Carton (55150-221-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-221-10,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etomidate: 10 Vial, Single-Dose In 1 Carton (55150-222-20)  / 20 Ml In 1 Vial, Single-Dose",636,RC,55150-222-20,NDC,,,facility,both,1,EA,,8.9,8.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-223-10,NDC,,,facility,both,1,EA,,4.42,4.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adenosine: 1 Vial, Single-Dose In 1 Carton (55150-193-01)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-193-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adenosine: 1 Vial, Single-Dose In 1 Carton (55150-193-01)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-193-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-163-30,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-167-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-167-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-167-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-167-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-168-30,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-169-10,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-170-30)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-170-30,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-171-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-171-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 10 Vial, Single-Dose In 1 Carton (55150-174-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-174-10,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 10 Vial, Single-Dose In 1 Carton (55150-174-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-174-10,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 10 Vial, Single-Dose In 1 Carton (55150-177-05)  / 5 Ml In 1 Vial, Single-Dose",636,RC,55150-177-05,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-223-10,NDC,,,facility,both,1,EA,,4.59,4.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-322-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-328-01,NDC,,,facility,both,1,EA,,16.61,16.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Medroxyprogesterone Acetate: 1 Vial, Single-Dose In 1 Carton (55150-329-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,55150-329-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prochlorperazine Edisylate: 1 Vial, Multi-Dose In 1 Carton (55150-360-01)  / 2 Ml In 1 Vial, Multi-Dose",636,RC,55150-360-01,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01)  / 12.5 Ml In 1 Vial, Single-Dose",636,RC,55150-365-01,NDC,,,facility,both,1,EA,,40.78,40.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vasopressin: 1 Vial, Multi-Dose In 1 Carton (55150-370-01)  / 1 Ml In 1 Vial, Multi-Dose",636,RC,55150-370-01,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-400-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55292-702-54,NDC,,,facility,both,1,EA,,61.27,61.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,9.47,9.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.61,14.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.62,14.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.68,14.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Panhematin: 1 Vial In 1 Carton (55292-702-55)  / 48 Ml In 1 Vial (55292-702-54),636,RC,55292-702-55,NDC,,,facility,both,1,EA,,61.27,61.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-322-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-322-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 1 Vial, Single-Dose In 1 Carton (55150-308-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-308-01,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-235-01,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-236-01,NDC,,,facility,both,1,EA,,43.6,43.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Sodium Phosphate: 25 Vial, Single-Dose In 1 Carton (55150-237-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,55150-237-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Linezolid: 10 Pouch In 1 Carton (55150-242-51)  / 1 Bag In 1 Pouch / 300 Ml In 1 Bag,636,RC,55150-242-51,NDC,,,facility,both,1,EA,,4.2,4.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levetiracetam: 10 Pouch In 1 Carton (55150-247-47)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,55150-247-47,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Carton (55150-251-10)  / 10 Ml In 1 Vial, Multi-Dose",636,RC,55150-251-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetylcysteine: 4 Vial, Single-Dose In 1 Carton (55150-259-30)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-259-30,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetylcysteine: 4 Vial, Single-Dose In 1 Carton (55150-259-30)  / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-259-30,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluphenazine Decanoate: 1 Vial, Multi-Dose In 1 Carton (55150-267-05)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,55150-267-05,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-273-01,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-20)  / 1 Injection In 1 Vial, Single-Dose",636,RC,55150-282-20,NDC,,,facility,both,1,EA,,23.27,23.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-20)  / 1 Injection In 1 Vial, Single-Dose",636,RC,55150-282-20,NDC,,,facility,both,1,EA,,23.23,23.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55150-304-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose",636,RC,55150-162-05,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (55111-153-30)",636,RC,55111-153-30,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (55111-153-30)",636,RC,55111-153-30,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclophosphamide: 100 Capsule In 1 Bottle (54879-021-01),636,RC,54879-021-01,NDC,,,facility,both,1,EA,,5.16,5.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Promethazine Hydrochloride: 100 Tablet In 1 Bottle (53746-745-01),636,RC,53746-745-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Promethazine Hydrochloride: 100 Tablet In 1 Bottle (53746-745-01),636,RC,53746-745-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoledronic Acid: 1 Vial In 1 Carton (54288-100-01)  / 5 Ml In 1 Vial,636,RC,54288-100-01,NDC,,,facility,both,1,EA,,9.79,9.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zoledronic Acid: 1 Vial In 1 Carton (54288-100-01)  / 5 Ml In 1 Vial,636,RC,54288-100-01,NDC,,,facility,both,1,EA,,9.67,9.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,54288-103-01,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 25 Vial In 1 Carton (54288-119-25)  / 1 Ml In 1 Vial,636,RC,54288-119-25,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epinephrine: 1 Vial In 1 Carton (54288-120-01)  / 10 Ml In 1 Vial,636,RC,54288-120-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,54288-137-01,NDC,,,facility,both,1,EA,,56.26,56.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,54288-141-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carnitor: 5 Vial In 1 Carton (54482-147-01)  / 5 Ml In 1 Vial,636,RC,54482-147-01,NDC,,,facility,both,1,EA,,46.31,46.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-117-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-117-20,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-117-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-117-20,NDC,,,facility,both,1,EA,,3.3,3.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-119-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-119-30,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-120-30,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-121-50,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-121-50,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 1 Vial, Multi-Dose In 1 Carton (55150-126-20)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,55150-126-20,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxacillin: 10 Vial In 1 Box (55150-128-24)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-128-24,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxacillin: 10 Vial In 1 Box (55150-128-24)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-128-24,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-154-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-154-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-154-10)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-154-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-155-20)  / 20 Ml In 1 Vial, Single-Dose",636,RC,55150-155-20,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-116-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-116-20,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-678-10)  / .5 Ml In 1 Syringe (55111-678-11),636,RC,55111-678-10,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55111-678-11,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,2.76,2.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,2.67,2.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Box (55150-113-10)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-113-10,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Box (55150-114-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-114-20,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ampicillin: 10 Vial In 1 Box (55150-114-20)  / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-114-20,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-023-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,90.26,90.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simponi Aria: 1 Vial, Single-Dose In 1 Carton (57894-350-01)  / 4 Ml In 1 Vial, Single-Dose",636,RC,57894-350-01,NDC,,,facility,both,1,EA,,75.75,75.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simponi Aria: 1 Vial, Single-Dose In 1 Carton (57894-350-01)  / 4 Ml In 1 Vial, Single-Dose",636,RC,57894-350-01,NDC,,,facility,both,1,EA,,75.64,75.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simponi Aria: 1 Vial, Single-Dose In 1 Carton (57894-350-01)  / 4 Ml In 1 Vial, Single-Dose",636,RC,57894-350-01,NDC,,,facility,both,1,EA,,76.79,76.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01)  / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,42.15,42.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01)  / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,40.84,40.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01)  / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,40.57,40.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01)  / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,40.84,40.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose",636,RC,57894-505-20,NDC,,,facility,both,1,EA,,150.42,150.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose",636,RC,57894-505-20,NDC,,,facility,both,1,EA,,143.4,143.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,90.06,90.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose",636,RC,57894-505-20,NDC,,,facility,both,1,EA,,151.26,151.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,90.26,90.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,90.03,90.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (57237-077-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,57237-077-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ondansetron: 3 Blister Pack In 1 Carton (57237-077-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,57237-077-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58406-010-01,NDC,,,facility,both,1,EA,,1843.54,1843.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58406-010-01,NDC,,,facility,both,1,EA,,1811.83,1811.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-976-02,NDC,,,facility,both,1,EA,,168.3,168.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
M-Dryl: 473 Ml In 1 Bottle (58657-528-16),636,RC,58657-528-16,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
M-Dryl: 473 Ml In 1 Bottle (58657-528-16),636,RC,58657-528-16,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-958-01,NDC,,,facility,both,1,EA,,219.65,219.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Menveo: 1 Kit In 1 Carton (58160-955-09)  *  .5 Ml In 1 Vial, Single-Dose (58160-958-01)  *  .5 Ml In 1 Vial, Single-Dose (58160-959-01)",636,RC,58160-955-09,NDC,,,facility,both,1,EA,,220.36,220.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-820-43,NDC,,,facility,both,1,EA,,38.99,38.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-821-01,NDC,,,facility,both,1,EA,,91.55,91.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-826-43,NDC,,,facility,both,1,EA,,134.81,134.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-827-03,NDC,,,facility,both,1,EA,,215.67,215.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-828-03,NDC,,,facility,both,1,EA,,381.11,381.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-842-01,NDC,,,facility,both,1,EA,,71.98,71.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-842-01,NDC,,,facility,both,1,EA,,65.31,65.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-842-43,NDC,,,facility,both,1,EA,,73.16,73.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-842-43,NDC,,,facility,both,1,EA,,74.01,74.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,58160-842-43,NDC,,,facility,both,1,EA,,73.4,73.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Boostrix: 10 Syringe In 1 Carton (58160-842-52)  / .5 Ml In 1 Syringe (58160-842-43),636,RC,58160-842-52,NDC,,,facility,both,1,EA,,73.33,73.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Firmagon: 1 Kit In 1 Carton (55566-8403-1)  *  3 Ml In 1 Syringe *  3 Ml In 1 Vial, Glass",636,RC,55566-8403-1,NDC,,,facility,both,1,EA,,8.17,8.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.5,14.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,5.4,5.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.63,14.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,11.71,11.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.36,14.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,9.12,9.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,14.65,14.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,14.63,14.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,11.71,11.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-126-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,55513-132-01,NDC,,,facility,both,1,EA,,118.26,118.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,55513-132-01,NDC,,,facility,both,1,EA,,119.46,119.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-144-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.4,14.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.46,14.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.66,14.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-023-01,NDC,,,facility,both,1,EA,,14.57,14.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-023-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-023-01,NDC,,,facility,both,1,EA,,14.66,14.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-023-01,NDC,,,facility,both,1,EA,,14.66,14.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-023-01,NDC,,,facility,both,1,EA,,9.72,9.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,12.38,12.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,8.91,8.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,10.26,10.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.68,14.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.67,14.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.59,14.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,8.72,8.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.59,14.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.61,14.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,14.43,14.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.7,14.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.63,14.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,9.63,9.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,14.61,14.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-144-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neulasta: 1 Syringe In 1 Carton (55513-190-01)  / .6 Ml In 1 Syringe,636,RC,55513-190-01,NDC,,,facility,both,1,EA,,681.26,681.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neulasta: 1 Syringe In 1 Carton (55513-190-01)  / .6 Ml In 1 Syringe,636,RC,55513-190-01,NDC,,,facility,both,1,EA,,681.26,681.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,58.86,58.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,56.6,56.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,58.95,58.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,57.37,57.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,59.22,59.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,57.38,57.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,59.2,59.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,54.65,54.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,52.57,52.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,54.43,54.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,52.54,52.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,54.49,54.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Evenity: 2 Syringe, Glass In 1 Carton (55513-998-02)  / 1.17 Ml In 1 Syringe, Glass (55513-998-01)",636,RC,55513-998-02,NDC,,,facility,both,1,EA,,24.44,24.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Evenity: 2 Syringe, Glass In 1 Carton (55513-998-02)  / 1.17 Ml In 1 Syringe, Glass (55513-998-01)",636,RC,55513-998-02,NDC,,,facility,both,1,EA,,23.81,23.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Evenity: 2 Syringe, Glass In 1 Carton (55513-998-02)  / 1.17 Ml In 1 Syringe, Glass (55513-998-01)",636,RC,55513-998-02,NDC,,,facility,both,1,EA,,24.46,24.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Evenity: 2 Syringe, Glass In 1 Carton (55513-998-02)  / 1.17 Ml In 1 Syringe, Glass (55513-998-01)",636,RC,55513-998-02,NDC,,,facility,both,1,EA,,23.76,23.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,56.6,56.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,7.73,7.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-670-01,NDC,,,facility,both,1,EA,,92.68,92.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-670-01,NDC,,,facility,both,1,EA,,85.11,85.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe,636,RC,55513-192-01,NDC,,,facility,both,1,EA,,681.26,681.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe,636,RC,55513-192-01,NDC,,,facility,both,1,EA,,679.37,679.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe,636,RC,55513-192-01,NDC,,,facility,both,1,EA,,681.26,681.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe,636,RC,55513-192-01,NDC,,,facility,both,1,EA,,678.54,678.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,102.74,102.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,100.41,100.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,91.57,91.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,95.4,95.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,90.38,90.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,90.77,90.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,100.41,100.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,93.52,93.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,90.77,90.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nplate: 1 Vial In 1 Carton (55513-221-01)  / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,205.54,205.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nplate: 1 Vial In 1 Carton (55513-221-01)  / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,24.18,24.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nplate: 1 Vial In 1 Carton (55513-221-01)  / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,38.3,38.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01)  / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,21.09,21.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01)  / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,21.58,21.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Riabni: 1 Vial, Single-Dose In 1 Carton (55513-224-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-224-01,NDC,,,facility,both,1,EA,,93.73,93.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-267-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,55513-267-01,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Riabni: 1 Vial, Single-Dose In 1 Carton (55513-326-01)  / 50 Ml In 1 Vial, Single-Dose",636,RC,55513-326-01,NDC,,,facility,both,1,EA,,95.62,95.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-670-01,NDC,,,facility,both,1,EA,,85.11,85.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-472-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensorcaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-472-17)  / 10 Ml In 1 Vial, Single-Dose (63323-472-03)",636,RC,63323-472-17,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensorcaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-472-17)  / 10 Ml In 1 Vial, Single-Dose (63323-472-03)",636,RC,63323-472-17,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-474-00,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nesacaine: 25 Vial, Multi-Dose In 1 Tray (63323-476-37)  / 30 Ml In 1 Vial, Multi-Dose (63323-476-01)",636,RC,63323-476-37,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-477-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nesacaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-477-27)  / 20 Ml In 1 Vial, Single-Dose (63323-477-01)",636,RC,63323-477-27,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol Decanoate: 1 Vial In 1 Carton (63323-469-01)  / 1 Ml In 1 Vial,636,RC,63323-469-01,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-478-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-486-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-486-05,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-466-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sensorcaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-462-17)  / 10 Ml In 1 Vial, Single-Dose (63323-462-04)",636,RC,63323-462-17,NDC,,,facility,both,1,EA,,8.88,8.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-398-01,NDC,,,facility,both,1,EA,,13.42,13.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-401-01,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-402-01,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-402-01,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-412-18,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-415-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Flumazenil: 10 Vial, Multi-Dose In 1 Tray (63323-424-05)  / 5 Ml In 1 Vial, Multi-Dose (63323-424-01)",636,RC,63323-424-05,NDC,,,facility,both,1,EA,,5.36,5.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-434-41,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-452-00,NDC,,,facility,both,1,EA,,5.17,5.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-452-00,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-462-01,NDC,,,facility,both,1,EA,,12.26,12.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-57)  / 50 Ml In 1 Vial, Multi-Dose (63323-486-05)",636,RC,63323-486-57,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colistimethate: 1 Vial In 1 Box (63323-393-06)  / 2 Ml In 1 Vial,636,RC,63323-393-06,NDC,,,facility,both,1,EA,,19.84,19.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-530-21,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-535-01,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-535-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-540-03,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-540-03,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-540-05,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Tray (63323-540-13)  / 1 Ml In 1 Vial (63323-540-03),636,RC,63323-540-13,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium: 25 Vial In 1 Tray (63323-540-15)  / 10 Ml In 1 Vial (63323-540-05),636,RC,63323-540-15,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-559-21,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bivalirudin: 10 Vial, Single-Use In 1 Carton (63323-562-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,63323-562-10,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-564-21,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-564-21,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-579-01,NDC,,,facility,both,1,EA,,57.49,57.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-559-21,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-523-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-523-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-492-07,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-492-09,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-495-27)  / 2 Ml In 1 Vial, Single-Dose (63323-495-09)",636,RC,63323-495-27,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-508-01,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meropenem: 10 Vial In 1 Carton (63323-508-30)  / 20 Ml In 1 Vial (63323-508-01),636,RC,63323-508-30,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-517-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefotetan: 10 Vial In 1 Carton (63323-386-20)  / 20 Ml In 1 Vial (63323-386-01),636,RC,63323-386-20,NDC,,,facility,both,1,EA,,35.16,35.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-386-01,NDC,,,facility,both,1,EA,,35.49,35.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-30)  / 25 Ml In 1 Vial, Single-Dose",636,RC,63323-229-30,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-95)  / 25 Ml In 1 Vial, Single-Dose",636,RC,63323-229-95,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-95)  / 25 Ml In 1 Vial, Single-Dose",636,RC,63323-229-95,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-262-03,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-262-03,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-10)  / 10 Ml In 1 Vial (63323-269-01),636,RC,63323-269-10,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-269-22,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-29)  / 20 Ml In 1 Vial (63323-269-22),636,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-269-30,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-269-35,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-37)  / 20 Ml In 1 Vial (63323-269-25),636,RC,63323-269-37,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 20 Vial In 1 Box (63323-269-50)  / 50 Ml In 1 Vial (63323-269-30),636,RC,63323-269-50,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 20 Vial In 1 Box (63323-269-50)  / 50 Ml In 1 Vial (63323-269-30),636,RC,63323-269-50,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-29)  / 20 Ml In 1 Vial (63323-269-22),636,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Protamine Sulfate: 25 Vial, Single-Dose In 1 Tray (63323-229-05)  / 5 Ml In 1 Vial, Single-Dose (63323-229-01)",636,RC,63323-229-05,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-229-01,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine: 25 Vial, Single-Dose In 1 Tray (63323-208-05)  / 5 Ml In 1 Vial, Single-Dose (63323-208-01)",636,RC,63323-208-05,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-180-00,NDC,,,facility,both,1,EA,,12.91,12.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose",636,RC,63323-184-10,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-186-01,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-201-03,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-201-03,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 25 Vial In 1 Tray (63323-201-10)  / 10 Ml In 1 Vial (63323-201-03),636,RC,63323-201-10,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine: 25 Vial, Single-Dose In 1 Tray (63323-208-05)  / 5 Ml In 1 Vial, Single-Dose (63323-208-01)",636,RC,63323-208-05,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diprivan: 10 Vial In 1 Box (63323-269-65)  / 100 Ml In 1 Vial (63323-269-35),636,RC,63323-269-65,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01),636,RC,63323-280-02,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tobramycin: 25 Vial, Multi-Dose In 1 Tray (63323-306-02)  / 2 Ml In 1 Vial, Multi-Dose (63323-306-01)",636,RC,63323-306-02,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 1 Bottle In 1 Carton (63323-314-66)  / 100 Ml In 1 Bottle,636,RC,63323-314-66,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-322-01,NDC,,,facility,both,1,EA,,9.64,9.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-325-03,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-325-03,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-325-09,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-325-09,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-20)  / 20 Ml In 1 Vial, Single-Dose (63323-325-09)",636,RC,63323-325-20,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-349-01,NDC,,,facility,both,1,EA,,11.22,11.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-360-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-360-03,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-376-00,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-377-00,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-385-01,NDC,,,facility,both,1,EA,,36.26,36.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefotetan: 10 Vial In 1 Carton (63323-385-10)  / 10 Ml In 1 Vial (63323-385-01),636,RC,63323-385-10,NDC,,,facility,both,1,EA,,40.22,40.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-306-01,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01),636,RC,63323-280-02,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-280-05,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-280-05,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Tray (63323-280-10)  / 10 Ml In 1 Vial (63323-280-05),636,RC,63323-280-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 25 Vial In 1 Tray (63323-280-10)  / 10 Ml In 1 Vial (63323-280-05),636,RC,63323-280-10,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluphenazine Hydrochloride: 1 Vial In 1 Box (63323-281-10)  / 10 Ml In 1 Vial,636,RC,63323-281-10,NDC,,,facility,both,1,EA,,19.83,19.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluphenazine Hydrochloride: 1 Vial In 1 Box (63323-281-10)  / 10 Ml In 1 Vial,636,RC,63323-281-10,NDC,,,facility,both,1,EA,,19.83,19.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-284-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-285-07,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-285-23)  / 20 Ml In 1 Vial, Single-Dose (63323-285-07)",636,RC,63323-285-23,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-286-35)  / 30 Ml In 1 Vial, Single-Dose (63323-286-11)",636,RC,63323-286-35,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-286-35)  / 30 Ml In 1 Vial, Single-Dose (63323-286-11)",636,RC,63323-286-35,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-287-21)  / 20 Ml In 1 Vial, Single-Dose (63323-287-03)",636,RC,63323-287-21,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-288-03,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-288-07,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-288-21)  / 20 Ml In 1 Vial, Single-Dose (63323-288-07)",636,RC,63323-288-21,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-294-01,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Polocaine-Mpf: 25 Vial, Single-Dose In 1 Tray (63323-294-27)  / 20 Ml In 1 Vial, Single-Dose (63323-294-01)",636,RC,63323-294-27,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tobramycin: 6 Vial, Pharmacy Bulk Package In 1 Tray (63323-303-51)  / 30 Ml In 1 Vial, Pharmacy Bulk Package (63323-303-01)",636,RC,63323-303-51,NDC,,,facility,both,1,EA,,6.79,6.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Sodium Phosphate: 25 Vial, Multi-Dose In 1 Tray (63323-165-05)  / 5 Ml In 1 Vial, Multi-Dose (63323-165-03)",636,RC,63323-165-05,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-584-21,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enoxaparin Sodium: 10 Blister Pack In 1 Carton (63323-584-99)  / 1 Syringe In 1 Blister Pack (63323-584-21)  / .8 Ml In 1 Syringe,636,RC,63323-584-99,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63739-953-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63739-953-11,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,64253-900-30,NDC,,,facility,both,1,EA,,15.92,15.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Capsule In 1 Container (64380-722-06),636,RC,64380-722-06,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 100 Capsule In 1 Container (64380-722-06),636,RC,64380-722-06,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle, Plastic (64380-726-06)",636,RC,64380-726-06,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,64253-400-30,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prednisone: 100 Tablet In 1 Bottle, Plastic (64380-782-06)",636,RC,64380-782-06,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,64253-400-30,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,64253-400-30,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63833-835-01,NDC,,,facility,both,1,EA,,120.74,120.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kcentra: 1 Kit In 1 Carton (63833-386-02)  *  20 Ml In 1 Vial, Single-Use (63833-396-01)  *  20 Ml In 1 Vial, Single-Use (63833-761-20)",636,RC,63833-386-02,NDC,,,facility,both,1,EA,,4.24,4.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kcentra: 1 Kit In 1 Carton (63833-386-02)  *  20 Ml In 1 Vial, Single-Use (63833-396-01)  *  20 Ml In 1 Vial, Single-Use (63833-761-20)",636,RC,63833-386-02,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kcentra: 1 Kit In 1 Carton (63833-387-02)  *  40 Ml In 1 Vial, Single-Use (63833-397-01)  *  40 Ml In 1 Vial, Single-Use (63833-761-40)",636,RC,63833-387-02,NDC,,,facility,both,1,EA,,4.26,4.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kcentra: 1 Kit In 1 Carton (63833-387-02)  *  40 Ml In 1 Vial, Single-Use (63833-397-01)  *  40 Ml In 1 Vial, Single-Use (63833-761-40)",636,RC,63833-387-02,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63833-396-01,NDC,,,facility,both,1,EA,,4.26,4.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63833-396-01,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63833-397-01,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63833-397-01,NDC,,,facility,both,1,EA,,4.25,4.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humate-P: 1 Kit In 1 Carton (63833-616-02)  *  10 Ml In 1 Vial (63833-626-01)  *  10 Ml In 1 Vial, Single-Dose (63833-765-54)",636,RC,63833-616-02,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humate-P: 1 Kit In 1 Carton (63833-617-02)  *  15 Ml In 1 Vial (63833-627-01)  *  15 Ml In 1 Vial, Single-Dose (63833-765-55)",636,RC,63833-617-02,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63833-627-01,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Berinert: 1 Kit In 1 Carton (63833-825-02)  *  10 Ml In 1 Vial (63833-835-01)  *  10 Ml In 1 Vial (63833-765-15),636,RC,63833-825-02,NDC,,,facility,both,1,EA,,135.66,135.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide: 1 Vial In 1 Box (63323-658-20)  / 18 Ml In 1 Vial,636,RC,63323-658-20,NDC,,,facility,both,1,EA,,69.04,69.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-664-00,NDC,,,facility,both,1,EA,,3.14,3.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diphenhydramine: 25 Vial, Single-Dose In 1 Tray (63323-664-01)  / 1 Ml In 1 Vial, Single-Dose (63323-664-00)",636,RC,63323-664-01,NDC,,,facility,both,1,EA,,5.43,5.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-664-41,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-665-00,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Posaconazole: 1 Vial, Single-Dose In 1 Carton (63323-685-17)  / 16.7 Ml In 1 Vial, Single-Dose",636,RC,63323-685-17,NDC,,,facility,both,1,EA,,451.84,451.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-713-03,NDC,,,facility,both,1,EA,,4.78,4.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 10 Vial, Multi-Dose In 1 Tray (63323-738-09)  / 4 Ml In 1 Vial, Multi-Dose (63323-738-03)",636,RC,63323-738-09,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-739-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12)  / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",636,RC,63323-739-12,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12)  / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",636,RC,63323-739-12,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-751-00,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Leucovorin Calcium: 1 Vial In 1 Box (63323-710-50)  / 20 Ml In 1 Vial,636,RC,63323-710-50,NDC,,,facility,both,1,EA,,5.9,5.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorothiazide: 1 Vial In 1 Box (63323-658-20)  / 18 Ml In 1 Vial,636,RC,63323-658-20,NDC,,,facility,both,1,EA,,71.37,71.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-651-00,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-624-07,NDC,,,facility,both,1,EA,,5.13,5.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-586-21,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-586-21,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-589-21,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glucagon: 1 Kit In 1 Carton (63323-593-03)  *  1 Ml In 1 Vial, Single-Dose (63323-596-03)  *  1 Ml In 1 Vial, Single-Dose (63323-185-03)",636,RC,63323-593-03,NDC,,,facility,both,1,EA,,162.54,162.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Glucagon: 1 Kit In 1 Carton (63323-593-03)  *  1 Ml In 1 Vial, Single-Dose (63323-596-03)  *  1 Ml In 1 Vial, Single-Dose (63323-185-03)",636,RC,63323-593-03,NDC,,,facility,both,1,EA,,177.17,177.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-596-03,NDC,,,facility,both,1,EA,,188.99,188.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-596-03,NDC,,,facility,both,1,EA,,222.92,222.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-596-03,NDC,,,facility,both,1,EA,,182.84,182.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-604-00,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-614-00,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-614-00,NDC,,,facility,both,1,EA,,3,3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydralazine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (63323-614-01)  / 1 Ml In 1 Vial, Single-Dose (63323-614-00)",636,RC,63323-614-01,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amiodarone Hydrochloride: 25 Vial, Single-Dose In 1 Tray (63323-616-03)  / 3 Ml In 1 Vial, Single-Dose (63323-616-01)",636,RC,63323-616-03,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amiodarone Hydrochloride: 10 Vial, Single-Dose In 1 Tray (63323-616-09)  / 9 Ml In 1 Vial, Single-Dose (63323-616-02)",636,RC,63323-616-09,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-624-06,NDC,,,facility,both,1,EA,,3.7,3.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fentanyl Citrate: 1 Vial, Single-Dose In 1 Carton (63323-806-50)  / 50 Ml In 1 Vial, Single-Dose",636,RC,63323-806-50,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-812-01,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,95.85,95.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,95.96,95.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,95.77,95.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,95.96,95.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,95.69,95.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,95.96,95.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,95.75,95.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,95.96,95.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63361-243-88,NDC,,,facility,both,1,EA,,272.27,272.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-965-02,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-812-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-850-74,NDC,,,facility,both,1,EA,,15.19,15.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)",636,RC,63323-851-50,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)",636,RC,63323-851-50,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-930-00,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tigecycline: 10 Vial, Single-Dose In 1 Carton (63323-960-10)  / 5 Ml In 1 Vial, Single-Dose (63323-960-01)",636,RC,63323-960-10,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vaxelis: 10 Syringe In 1 Package (63361-243-15)  / .5 Ml In 1 Syringe (63361-243-88),636,RC,63361-243-15,NDC,,,facility,both,1,EA,,263.44,263.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-165-03,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-164-25,NDC,,,facility,both,1,EA,,9.5,9.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-854-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60793-700-01,NDC,,,facility,both,1,EA,,54.29,54.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60793-701-02,NDC,,,facility,both,1,EA,,50.52,50.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60793-701-02,NDC,,,facility,both,1,EA,,50.58,50.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etopophos: 1 Vial, Single-Dose In 1 Carton (61269-410-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61269-410-20,NDC,,,facility,both,1,EA,,30.79,30.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etopophos: 1 Vial, Single-Dose In 1 Carton (61269-410-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61269-410-20,NDC,,,facility,both,1,EA,,30.79,30.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etopophos: 1 Vial, Single-Dose In 1 Carton (61269-410-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61269-410-20,NDC,,,facility,both,1,EA,,30.79,30.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-854-11,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18)  / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-324-18,NDC,,,facility,both,1,EA,,25.25,25.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-56)  / 60 Ml In 1 Vial, Multi-Dose",636,RC,61703-339-56,NDC,,,facility,both,1,EA,,3.88,3.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (61703-342-50)  / 50 Ml In 1 Vial, Multi-Dose",636,RC,61703-342-50,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea: 1 Syringe, Glass In 1 Carton (61755-005-01)  / .05 Ml In 1 Syringe, Glass",636,RC,61755-005-01,NDC,,,facility,both,1,EA,,1869.62,1869.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea: 1 Syringe, Glass In 1 Carton (61755-005-01)  / .05 Ml In 1 Syringe, Glass",636,RC,61755-005-01,NDC,,,facility,both,1,EA,,1876.39,1876.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use",636,RC,61755-005-02,NDC,,,facility,both,1,EA,,1862.82,1862.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use",636,RC,61755-005-02,NDC,,,facility,both,1,EA,,1826.28,1826.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use",636,RC,61755-005-02,NDC,,,facility,both,1,EA,,1869.12,1869.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use",636,RC,61755-005-02,NDC,,,facility,both,1,EA,,1828.63,1828.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea Hd: 1 Vial, Single-Dose In 1 Carton (61755-050-01)  / .07 Ml In 1 Vial, Single-Dose (61755-050-00)",636,RC,61755-050-01,NDC,,,facility,both,1,EA,,655.78,655.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea Hd: 1 Vial, Single-Dose In 1 Carton (61755-050-01)  / .07 Ml In 1 Vial, Single-Dose (61755-050-00)",636,RC,61755-050-01,NDC,,,facility,both,1,EA,,648.27,648.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea Hd: 1 Vial, Single-Dose In 1 Carton (61755-050-01)  / .07 Ml In 1 Vial, Single-Dose (61755-050-00)",636,RC,61755-050-01,NDC,,,facility,both,1,EA,,658.46,658.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eylea Hd: 1 Vial, Single-Dose In 1 Carton (61755-050-01)  / .07 Ml In 1 Vial, Single-Dose (61755-050-00)",636,RC,61755-050-01,NDC,,,facility,both,1,EA,,643.13,643.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,61.18,61.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,61553-425-39,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zarxio: 1 Blister Pack In 1 Carton (61314-318-01)  / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe,636,RC,61314-318-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zarxio: 1 Blister Pack In 1 Carton (61314-318-01)  / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe,636,RC,61314-318-01,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,61314-326-05,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,61553-196-52,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-660-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,60687-660-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-165-01)  / 1 Ml In 1 Vial (63323-165-02),636,RC,63323-165-01,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-010-01,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gentamicin: 25 Vial In 1 Tray (63323-010-02)  / 2 Ml In 1 Vial (63323-010-01),636,RC,63323-010-02,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-010-03,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gentamicin: 25 Vial In 1 Tray (63323-010-20)  / 20 Ml In 1 Vial (63323-010-03),636,RC,63323-010-20,NDC,,,facility,both,1,EA,,4.34,4.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-012-03,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-013-01,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-024-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63037-173-25,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-212-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-212-01,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-212-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-212-01,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-212-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-212-01,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-212-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-212-01,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-212-01)  / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-212-01,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-215-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,62856-215-01,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-215-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,62856-215-01,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-215-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,62856-215-01,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-215-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,62856-215-01,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-215-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,62856-215-01,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leqembi: 1 Vial, Single-Dose In 1 Carton (62856-215-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,62856-215-01,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63037-173-25,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63037-173-25,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mannitol: 25 Vial, Single-Dose In 1 Tray (63323-024-25)  / 50 Ml In 1 Vial, Single-Dose (63323-024-01)",636,RC,63323-024-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-064-01,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-117-01,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-117-01,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10)  / 10 Ml In 1 Vial, Single-Dose (63323-117-00)",636,RC,63323-117-10,NDC,,,facility,both,1,EA,,3.14,3.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10)  / 10 Ml In 1 Vial, Single-Dose (63323-117-00)",636,RC,63323-117-10,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-61,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-61,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-130-02,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxy 100: 10 Vial In 1 Tray (63323-130-11)  / 10 Ml In 1 Vial (63323-130-02),636,RC,63323-130-11,NDC,,,facility,both,1,EA,,26.08,26.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-117-00,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-161-00,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-161-00,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-161-01)  / 1 Ml In 1 Vial, Single-Use (63323-161-00)",636,RC,63323-161-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-117-00,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-108-00,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Sulfate: 25 Vial, Single-Dose In 1 Carton (63323-064-03)  / 2 Ml In 1 Vial, Single-Dose (63323-064-01)",636,RC,63323-064-03,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-064-04,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-093-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cisplatin: 1 Vial In 1 Carton (63323-103-65)  / 100 Ml In 1 Vial,636,RC,63323-103-65,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etoposide: 1 Vial, Multi-Dose In 1 Carton (63323-104-25)  / 25 Ml In 1 Vial, Multi-Dose",636,RC,63323-104-25,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-106-00,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-106-00,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-106-02,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-106-02,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate: 24 Bag In 1 Case (63323-106-05)  / 50 Ml In 1 Bag (63323-106-02),636,RC,63323-106-05,NDC,,,facility,both,1,EA,,3.32,3.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate: 24 Bag In 1 Case (63323-106-15)  / 500 Ml In 1 Bag,636,RC,63323-106-15,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-108-00,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,63323-044-00,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 VIAL, SINGLE-DOSE in 1 CARTON (61958-2901-1)  / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE",636,RC,61958-2901-1,NDC,,,facility,both,1,EA,,889.2,889.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,12.54,12.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1174.99,1174.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1252.1,1252.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1190.16,1190.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1254.69,1254.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,11.94,11.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,12.59,12.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,12.44,12.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,10.43,10.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Epoprostenol: 1 Vial In 1 Carton (62756-059-40)  / 10 Ml In 1 Vial,636,RC,62756-059-40,NDC,,,facility,both,1,EA,,11.64,11.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (62756-459-83),636,RC,62756-459-83,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (62756-460-83),636,RC,62756-460-83,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,62332-599-01,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclophosphamide: 100 Capsule In 1 Bottle (62332-618-31),636,RC,62332-618-31,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclophosphamide: 100 Capsule In 1 Bottle (62332-618-31),636,RC,62332-618-31,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclophosphamide: 100 Capsule In 1 Bottle (62332-619-31),636,RC,62332-619-31,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,62332-628-05,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,62332-628-05,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorpromazine: 100 Tablet In 1 Bottle (62332-737-31),636,RC,62332-737-31,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-751-50)  / 50 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,62332-751-50,NDC,,,facility,both,1,EA,,9.19,9.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-779-31)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,62332-779-31,NDC,,,facility,both,1,EA,,9.56,9.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-779-31)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,62332-779-31,NDC,,,facility,both,1,EA,,10.43,10.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,ZZ61553-Z685-88,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-4277-16)",636,RC,0409-4277-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rifadin Iv: 1 Vial, Glass In 1 Carton (0068-0597-01)  / 10 Ml In 1 Vial, Glass",636,RC,0068-0597-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-0059-04,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-0059-04,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-0207-01,NDC,,,facility,both,1,EA,,479.15,479.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-0209-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
1 VIAL in 1 CARTON (0069-0234-01)  / 50 mL in 1 VIAL,636,RC,0069-0234-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0238-01)  / 10 Ml In 1 Vial, Single-Use",636,RC,0069-0238-01,NDC,,,facility,both,1,EA,,103.04,103.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
1 VIAL in 1 CARTON (0069-0248-01)  / 100 mL in 1 VIAL,636,RC,0069-0248-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0249-01)  / 50 Ml In 1 Vial, Single-Use",636,RC,0069-0249-01,NDC,,,facility,both,1,EA,,103.04,103.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0249-01)  / 50 Ml In 1 Vial, Single-Use",636,RC,0069-0249-01,NDC,,,facility,both,1,EA,,99.38,99.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nyvepria: 1 Carton In 1 Carton (0069-0324-01)  / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,313.23,313.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Abrysvo: 1 Tray In 1 Carton (0069-0344-01)  / 1 Kit In 1 Tray (0069-0344-21)  *  .5 Ml In 1 Vial, Glass (0069-0207-01)  *  .69 Ml In 1 Syringe, Glass (0069-0250-01)",636,RC,0069-0344-01,NDC,,,facility,both,1,EA,,487.83,487.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Abrysvo: 5 Tray In 1 Carton (0069-0344-05)  / 1 Kit In 1 Tray (0069-0344-21)  *  .5 Ml In 1 Vial, Glass (0069-0207-01)  *  .69 Ml In 1 Syringe, Glass (0069-0250-01)",636,RC,0069-0344-05,NDC,,,facility,both,1,EA,,469.19,469.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4181-25)",636,RC,0054-4181-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4181-25)",636,RC,0054-4181-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)",636,RC,0054-4183-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)",636,RC,0054-4183-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4184-25)",636,RC,0054-4184-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4184-25)",636,RC,0054-4184-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4186-25)",636,RC,0054-4186-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Blister Pack In 1 Carton (0054-8174-25)  / 1 Tablet In 1 Blister Pack,636,RC,0054-8174-25,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Blister Pack In 1 Carton (0054-8174-25)  / 1 Tablet In 1 Blister Pack,636,RC,0054-8174-25,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Blister Pack In 1 Carton (0054-8183-25)  / 1 Tablet In 1 Blister Pack,636,RC,0054-8183-25,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexamethasone: 100 Blister Pack In 1 Carton (0054-8183-25)  / 1 Tablet In 1 Blister Pack,636,RC,0054-8183-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4179-25)",636,RC,0054-4179-25,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,22.76,22.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1308-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1308-01)",636,RC,0069-1308-10,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,17.77,17.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,17.78,17.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,17.78,17.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,17.95,17.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 4 Vial, Single-Dose In 1 Carton (0069-1309-04)  / 1 Ml In 1 Vial, Single-Dose (0069-1309-01)",636,RC,0069-1309-04,NDC,,,facility,both,1,EA,,18.88,18.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-6001-02,NDC,,,facility,both,1,EA,,35.38,35.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-6001-10,NDC,,,facility,both,1,EA,,21.76,21.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cerebyx: 25 Vial In 1 Carton (0069-6001-25)  / 2 Ml In 1 Vial (0069-6001-02),636,RC,0069-6001-25,NDC,,,facility,both,1,EA,,30.45,30.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zemplar: 25 Vial, Single-Dose In 1 Tray (0074-1658-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0074-1658-01,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1305-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1305-01)",636,RC,0069-1305-10,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1306-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1306-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1306-01)",636,RC,0069-1306-10,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1306-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1306-01)",636,RC,0069-1306-10,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1307-01,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1307-01,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1307-01,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1307-01,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1307-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1307-01)",636,RC,0069-1307-10,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1307-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1307-01)",636,RC,0069-1307-10,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pfizerpen: 10 Vial In 1 Carton (0049-0520-83)  / 1 Powder, For Solution In 1 Vial (0049-0520-84)",636,RC,0049-0520-83,NDC,,,facility,both,1,EA,,9.68,9.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0049-0520-84,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pfizerpen: 1 Vial In 1 Carton (0049-0530-28)  / 1 Powder, For Solution In 1 Vial",636,RC,0049-0530-28,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vfend: 1 Vial, Single-Use In 1 Carton (0049-3190-01)  / 20 Ml In 1 Vial, Single-Use",636,RC,0049-3190-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vfend: 1 Vial, Single-Dose In 1 Carton (0049-3190-28)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0049-3190-28,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vfend: 1 Vial, Single-Dose In 1 Carton (0049-3190-28)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0049-3190-28,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0049-3920-20,NDC,,,facility,both,1,EA,,58.23,58.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 10 Blister Pack In 1 Carton (0054-0019-20)  / 10 Tablet In 1 Blister Pack,636,RC,0054-0019-20,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisone: 10 Blister Pack In 1 Carton (0054-0019-20)  / 10 Tablet In 1 Blister Pack,636,RC,0054-0019-20,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,33.55,33.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Elitek: 3 Kit In 1 Carton (0024-5150-10)  / 1 Kit In 1 Kit *  1 Ml In 1 Vial, Single-Use (0024-5154-11)  *  1 Ml In 1 Ampule (0024-5152-11)",636,RC,0024-5150-10,NDC,,,facility,both,1,EA,,723.24,723.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0024-5154-11,NDC,,,facility,both,1,EA,,723.24,723.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Premarin: 1 Vial In 1 Carton (0046-0749-05)  / 5 Ml In 1 Vial,636,RC,0046-0749-05,NDC,,,facility,both,1,EA,,681.14,681.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-0019-25)",636,RC,0054-0019-25,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-0019-25)",636,RC,0054-0019-25,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Intensol: 30 Ml In 1 Bottle, Glass (0054-3176-44)",636,RC,0054-3176-44,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Intensol: 30 Ml In 1 Bottle, Glass (0054-3176-44)",636,RC,0054-3176-44,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone: 500 Ml In 1 Bottle, Plastic (0054-3177-63)",636,RC,0054-3177-63,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0054-0163-25),636,RC,0054-0163-25,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0054-0163-25),636,RC,0054-0163-25,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (0054-0176-13),636,RC,0054-0176-13,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zemplar: 25 Vial, Single-Dose In 1 Tray (0074-1658-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0074-1658-01,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclophosphamide: 100 Capsule In 1 Bottle (0054-0383-25),636,RC,0054-0383-25,NDC,,,facility,both,1,EA,,12.42,12.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buprenorphine: 30 Tablet In 1 Bottle (0054-0176-13),636,RC,0054-0176-13,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gengraf: 5 Blister Pack In 1 Carton (0074-3109-32)  / 6 Capsule In 1 Blister Pack,636,RC,0074-3109-32,NDC,,,facility,both,1,EA,,6.54,6.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0121-0489-05,NDC,,,facility,both,1,EA,,7.36,7.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0121-0489-05,NDC,,,facility,both,1,EA,,10.15,10.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle (0121-0759-08),636,RC,0121-0759-08,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0093-9018-19,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclosporine Modified: 30 Blister Pack In 1 Carton (0093-9018-65)  / 1 Capsule, Liquid Filled In 1 Blister Pack (0093-9018-19)",636,RC,0093-9018-65,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0121-0978-10,NDC,,,facility,both,1,EA,,8.59,8.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0121-0977-55,NDC,,,facility,both,1,EA,,33.65,33.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0121-0978-10,NDC,,,facility,both,1,EA,,3.74,3.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cabergoline: 1 Bottle In 1 Carton (0093-5420-88)  / 8 Tablet In 1 Bottle,636,RC,0093-5420-88,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,411.81,411.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,412.99,412.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,411.14,411.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,412.99,412.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81)  *  2 Ml In 1 Syringe *  6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,412.28,412.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81)  *  2 Ml In 1 Syringe *  6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,410.84,410.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Integrilin: 1 VIAL, SINGLE-USE in 1 CARTON (0085-1136-01)  / 100 mL in 1 VIAL, SINGLE-USE",636,RC,0085-1136-01,NDC,,,facility,both,1,EA,,65.76,65.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass",636,RC,0088-2220-33,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass",636,RC,0088-2220-33,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass",636,RC,0088-2220-33,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0078-0804-61,NDC,,,facility,both,1,EA,,412.28,412.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0078-0797-61,NDC,,,facility,both,1,EA,,412.99,412.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet,636,RC,0074-3663-03,NDC,,,facility,both,1,EA,,3255.2,3255.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet,636,RC,0074-3663-03,NDC,,,facility,both,1,EA,,3177.7,3177.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gengraf: 1 Bottle In 1 Carton (0074-7269-50)  / 50 Ml In 1 Bottle,636,RC,0074-7269-50,NDC,,,facility,both,1,EA,,5.51,5.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0075-0620-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0075-0622-01,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0078-0109-61,NDC,,,facility,both,1,EA,,74.19,74.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0078-0797-61,NDC,,,facility,both,1,EA,,412.99,412.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),636,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),636,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,33.44,33.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,32.64,32.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,33.68,33.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5192712020,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5556641000,NDC,,,facility,both,1,EA,,198.81,198.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5556641000,NDC,,,facility,both,1,EA,,198.81,198.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5556641001,NDC,,,facility,both,1,EA,,195.61,195.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5556641001,NDC,,,facility,both,1,EA,,198.81,198.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5556641001,NDC,,,facility,both,1,EA,,195.35,195.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5556641001,NDC,,,facility,both,1,EA,,198.81,198.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5846800903,NDC,,,facility,both,1,EA,,16.56,16.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,5846800903,NDC,,,facility,both,1,EA,,16.31,16.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,6425333333,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,6425333333,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-5423-02,NDC,,,facility,both,1,EA,,231.59,231.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Protonix I.V.: 1 Vial In 1 Carton (0008-0923-51)  / 10 Ml In 1 Vial,636,RC,0008-0923-51,NDC,,,facility,both,1,EA,,4.71,4.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0008-1030-04,NDC,,,facility,both,1,EA,,59.19,59.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Medrol: 1 Vial In 1 Carton (0009-0003-02)  / 4 Ml In 1 Vial,636,RC,0009-0003-02,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Medrol: 1 Vial In 1 Carton (0009-0003-02)  / 4 Ml In 1 Vial,636,RC,0009-0003-02,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0011-03,NDC,,,facility,both,1,EA,,20.71,20.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0011-03,NDC,,,facility,both,1,EA,,22.47,22.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Solu-Cortef: 1 Vial, Single-Dose In 1 Carton (0009-0013-05)  / 2 Ml In 1 Vial, Single-Dose",636,RC,0009-0013-05,NDC,,,facility,both,1,EA,,32.02,32.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Solu-Cortef: 1 Vial, Single-Dose In 1 Carton (0009-0013-05)  / 2 Ml In 1 Vial, Single-Dose",636,RC,0009-0013-05,NDC,,,facility,both,1,EA,,31.26,31.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial,636,RC,0009-0018-20,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial,636,RC,0009-0018-20,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4897-01,NDC,,,facility,both,1,EA,,56.1,56.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,115.6,115.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,89.47,89.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,85.59,85.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,113.33,113.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,113.72,113.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,113.33,113.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,114.03,114.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,113.33,113.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4095-01,NDC,,,facility,both,1,EA,,55.15,55.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4121-01,NDC,,,facility,both,1,EA,,579.04,579.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4681-01,NDC,,,facility,both,1,EA,,171.94,171.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00)  / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)",636,RC,0006-4827-00,NDC,,,facility,both,1,EA,,340.57,340.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4827-01,NDC,,,facility,both,1,EA,,346.75,346.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4837-01,NDC,,,facility,both,1,EA,,224.02,224.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4837-01,NDC,,,facility,both,1,EA,,222.59,222.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0006-4943-01,NDC,,,facility,both,1,EA,,222.59,222.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.67,12.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.6,12.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.67,12.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,11.8,11.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.81,12.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.67,12.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,11.05,11.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.67,12.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch,636,RC,0023-3348-07,NDC,,,facility,both,1,EA,,384.44,384.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch,636,RC,0023-3348-07,NDC,,,facility,both,1,EA,,384.44,384.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch,636,RC,0023-3348-07,NDC,,,facility,both,1,EA,,381.82,381.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch,636,RC,0023-3348-07,NDC,,,facility,both,1,EA,,384.44,384.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,16.84,16.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,33.68,33.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,50.13,50.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,32.43,32.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,31.86,31.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,32.7,32.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,11.29,11.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0775-20,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Solu-Cortef: 1 Vial In 1 Carton (0009-0825-01)  / 2 Ml In 1 Vial,636,RC,0009-0825-01,NDC,,,facility,both,1,EA,,28.26,28.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0870-21,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3475-01)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3475-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0009-0902-11,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,8290306423,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,8290306423,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-0213-01)  / 3 Ml In 1 Vial, Multi-Dose",636,RC,0002-0213-01,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gemzar: 25 mL in 1 VIAL, SINGLE-DOSE (0002-7502-01) ",636,RC,0002-7502-01,NDC,,,facility,both,1,EA,,280.33,280.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alimta: 1 Vial In 1 Carton (0002-7623-01)  / 20 Ml In 1 Vial,636,RC,0002-7623-01,NDC,,,facility,both,1,EA,,146.14,146.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7669-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0002-7669-01,NDC,,,facility,both,1,EA,,142.77,142.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7669-01)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0002-7669-01,NDC,,,facility,both,1,EA,,145.83,145.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01)  / 10 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-01,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17)  / 3 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-17,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azactam: 10 Vial, Single-Dose In 1 Carton (0003-2570-16)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,0003-2570-16,NDC,,,facility,both,1,EA,,5.37,5.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,63.96,63.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,62.35,62.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,63.97,63.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,62.72,62.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,63.89,63.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,62.71,62.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,63.74,63.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,63.76,63.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,62.69,62.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,63.71,63.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,62.66,62.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Opdivo Qvantig: 1 Vial, Single-Dose In 1 Carton (0003-6120-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0003-6120-01,NDC,,,facility,both,1,EA,,41.48,41.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0005-2000-01,NDC,,,facility,both,1,EA,,463.72,463.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02)  / .5 Ml In 1 Syringe (0005-2000-01),636,RC,0005-2000-02,NDC,,,facility,both,1,EA,,432.94,432.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02)  / .5 Ml In 1 Syringe (0005-2000-01),636,RC,0005-2000-02,NDC,,,facility,both,1,EA,,452.8,452.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azactam: 10 Vial, Single-Dose In 1 Carton (0003-2570-16)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,0003-2570-16,NDC,,,facility,both,1,EA,,5.37,5.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,343.84,343.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,295,295,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,344.57,344.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17)  / 3 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-17,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Humulin R U-500: 1 Vial, Multi-Dose In 1 Carton (0002-8501-01)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,0002-8501-01,NDC,,,facility,both,1,EA,,10.28,10.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kisunla: 1 Vial, Single-Dose In 1 Carton (0002-9401-01)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0002-9401-01,NDC,,,facility,both,1,EA,,7.89,7.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kisunla: 1 Vial, Single-Dose In 1 Carton (0002-9401-01)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0002-9401-01,NDC,,,facility,both,1,EA,,7.79,7.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kisunla: 1 Vial, Single-Dose In 1 Carton (0002-9401-01)  / 20 Ml In 1 Vial, Single-Dose",636,RC,0002-9401-01,NDC,,,facility,both,1,EA,,7.83,7.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kenalog-40: 1 Vial, Single-Dose In 1 Carton (0003-0293-05)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0003-0293-05,NDC,,,facility,both,1,EA,,4.23,4.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kenalog-40: 1 Vial, Single-Dose In 1 Carton (0003-0293-05)  / 1 Ml In 1 Vial, Single-Dose",636,RC,0003-0293-05,NDC,,,facility,both,1,EA,,4.23,4.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kenalog-40: 1 Vial, Multi-Dose In 1 Carton (0003-0293-20)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,0003-0293-20,NDC,,,facility,both,1,EA,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kenalog-10: 1 Vial, Multi-Dose In 1 Carton (0003-0494-20)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,0003-0494-20,NDC,,,facility,both,1,EA,,4.37,4.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Kenalog-10: 1 Vial, Multi-Dose In 1 Carton (0003-0494-20)  / 5 Ml In 1 Vial, Multi-Dose",636,RC,0003-0494-20,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use",636,RC,0003-2187-13,NDC,,,facility,both,1,EA,,112.1,112.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use",636,RC,0003-2187-13,NDC,,,facility,both,1,EA,,115.75,115.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use",636,RC,0003-2187-13,NDC,,,facility,both,1,EA,,112.66,112.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use",636,RC,0003-2187-13,NDC,,,facility,both,1,EA,,116.11,116.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use",636,RC,0003-2187-13,NDC,,,facility,both,1,EA,,114.21,114.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,345.62,345.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,344.53,344.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,350.4,350.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)",636,RC,0406-0527-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0378-7970-31,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0378-8270-31,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0378-8270-31,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0378-8765-16,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag,636,RC,0338-0049-11,NDC,,,facility,both,1,EA,,3.47,3.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag,636,RC,0338-0049-18,NDC,,,facility,both,1,EA,,3.69,3.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag,636,RC,0338-0049-18,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Bag In 1 Package (0338-0049-31)  / 50 Ml In 1 Bag,636,RC,0338-0049-31,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Bag In 1 Package (0338-0049-38)  / 100 Ml In 1 Bag,636,RC,0338-0049-38,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Bag In 1 Package (0338-0049-38)  / 100 Ml In 1 Bag,636,RC,0338-0049-38,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1 Bag In 1 Package (0338-0049-41)  / 50 Ml In 1 Bag,636,RC,0338-0049-41,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1 Bag In 1 Package (0338-0049-48)  / 100 Ml In 1 Bag,636,RC,0338-0049-48,NDC,,,facility,both,1,EA,,4.24,4.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 10 Vial In 1 Carton (0338-0069-10)  / 1 Ml In 1 Vial,636,RC,0338-0069-10,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial,636,RC,0338-0072-25,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0077-04)  / 1000 Ml In 1 Bag,636,RC,0338-0077-04,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 24 Bag In 1 Carton (0338-0085-03)  / 500 Ml In 1 Bag,636,RC,0338-0085-03,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0085-04)  / 1000 Ml In 1 Bag,636,RC,0338-0085-04,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0089-04)  / 1000 Ml In 1 Bag,636,RC,0338-0089-04,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0089-04)  / 1000 Ml In 1 Bag,636,RC,0338-0089-04,NDC,,,facility,both,1,EA,,1.98,1.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 500 Ml In 1 Bag (0338-0117-03),636,RC,0338-0117-03,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 4 Bag In 1 Package (0338-0049-10)  / 25 Ml In 1 Bag,636,RC,0338-0049-10,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 4 Bag In 1 Pouch (0338-0017-18)  / 100 Ml In 1 Bag,636,RC,0338-0017-18,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 16 Bag In 1 Pouch (0338-0017-31)  / 50 Ml In 1 Bag,636,RC,0338-0017-31,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 250 Ml In 1 Bag (0338-0023-02),636,RC,0338-0023-02,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 500 Ml In 1 Bag (0338-0023-03),636,RC,0338-0023-03,NDC,,,facility,both,1,EA,,6.48,6.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 1000 Ml In 1 Bag (0338-0023-04),636,RC,0338-0023-04,NDC,,,facility,both,1,EA,,5.84,5.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04),636,RC,0338-0043-04,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04),636,RC,0338-0043-04,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 6 Bag In 1 Carton (0338-0047-46)  / 2000 Ml In 1 Bag,636,RC,0338-0047-46,NDC,,,facility,both,1,EA,,8.82,8.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03)  / 500 Ml In 1 Bottle, Plastic",636,RC,0338-0048-03,NDC,,,facility,both,1,EA,,2.79,2.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),636,RC,0338-0049-02,NDC,,,facility,both,1,EA,,4.03,4.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),636,RC,0338-0049-02,NDC,,,facility,both,1,EA,,5.07,5.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),636,RC,0338-0049-02,NDC,,,facility,both,1,EA,,4.88,4.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03),636,RC,0338-0049-03,NDC,,,facility,both,1,EA,,4.93,4.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03),636,RC,0338-0049-03,NDC,,,facility,both,1,EA,,5.01,5.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),636,RC,0338-0049-04,NDC,,,facility,both,1,EA,,3.81,3.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),636,RC,0338-0049-04,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),636,RC,0338-0117-04,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),636,RC,0338-0117-04,NDC,,,facility,both,1,EA,,3.38,3.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48)  / 100 Ml In 1 Bag,636,RC,0338-0709-48,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 2000 Ml In 1 Bag (0338-0719-06),636,RC,0338-0719-06,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1007-02)  / 250 Ml In 1 Bag,636,RC,0338-1007-02,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitroglycerin In Dextrose: 12 Bottle, Glass In 1 Box (0338-1051-02)  / 250 Ml In 1 Bottle, Glass",636,RC,0338-1051-02,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag,636,RC,0338-1055-48,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag,636,RC,0338-1055-48,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag,636,RC,0338-1075-02,NDC,,,facility,both,1,EA,,29.38,29.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag,636,RC,0338-1075-02,NDC,,,facility,both,1,EA,,29.64,29.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1077-02)  / 250 Ml In 1 Bag,636,RC,0338-1077-02,NDC,,,facility,both,1,EA,,10.32,10.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 40 Bag In 1 Case (0338-1709-40)  / 100 Ml In 1 Bag,636,RC,0338-1709-40,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0338-3612-50,NDC,,,facility,both,1,EA,,4.81,4.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0338-3612-50,NDC,,,facility,both,1,EA,,4.82,4.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0338-3814-50,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0338-3814-50,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 10 Bag In 1 Carton (0338-6045-37)  / 200 Ml In 1 Bag,636,RC,0338-6045-37,NDC,,,facility,both,1,EA,,18.58,18.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),636,RC,0338-9159-30,NDC,,,facility,both,1,EA,,5.69,5.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),636,RC,0338-9159-30,NDC,,,facility,both,1,EA,,5.73,5.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 250 Ml In 1 Bag (0338-9543-02),636,RC,0338-9543-02,NDC,,,facility,both,1,EA,,8.55,8.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48)  / 100 Ml In 1 Bag,636,RC,0338-0709-48,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 24 Bag In 1 Carton (0338-0705-48)  / 100 Ml In 1 Bag,636,RC,0338-0705-48,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0125-04),636,RC,0338-0125-04,NDC,,,facility,both,1,EA,,3.93,3.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Myxredlin: 12 Container In 1 Carton (0338-0126-12)  / 100 Ml In 1 Container,636,RC,0338-0126-12,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Osmitrol: 500 Ml In 1 Bag (0338-0357-03),636,RC,0338-0357-03,NDC,,,facility,both,1,EA,,8.84,8.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag,636,RC,0338-0411-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag,636,RC,0338-0411-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18),636,RC,0338-0553-18,NDC,,,facility,both,1,EA,,5.3,5.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18),636,RC,0338-0553-18,NDC,,,facility,both,1,EA,,5.37,5.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose: 1000 Ml In 1 Bag (0338-0683-04),636,RC,0338-0683-04,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0691-04)  / 1000 Ml In 1 Bag,636,RC,0338-0691-04,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0695-04)  / 1000 Ml In 1 Bag,636,RC,0338-0695-04,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0704-34)  / 1000 Ml In 1 Bag,636,RC,0338-0704-34,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 100 Ml In 1 Bag (0338-0551-18),636,RC,0338-0551-18,NDC,,,facility,both,1,EA,,5.3,5.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2050-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0409-2267-20)  / 20 Ml In 1 Vial, Multi-Dose",636,RC,0409-2267-20,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 10 Vial, Single-Dose In 1 Carton (0409-2305-05)  / 5 Ml In 1 Vial, Single-Dose (0409-2305-04)",636,RC,0409-2305-05,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2305-16,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",636,RC,0409-2305-17,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",636,RC,0409-2305-17,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",636,RC,0409-2305-17,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2308-21,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2339-24,NDC,,,facility,both,1,EA,,5.1,5.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dobutamine: 10 Vial, Single-Dose In 1 Tray (0409-2344-02)  / 20 Ml In 1 Vial, Single-Dose (0409-2344-62)",636,RC,0409-2344-02,NDC,,,facility,both,1,EA,,9.21,9.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2344-62,NDC,,,facility,both,1,EA,,11.86,11.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2347-31,NDC,,,facility,both,1,EA,,10.29,10.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2347-31,NDC,,,facility,both,1,EA,,10.62,10.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefazolin: 25 Vial In 1 Carton (0409-2585-01)  / 1 Injection, Powder, For Solution In 1 Vial (0409-2585-11)",636,RC,0409-2585-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose",636,RC,0409-2634-50,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose",636,RC,0409-2634-50,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2720-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2720-30)",636,RC,0409-2720-01,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2045-01,NDC,,,facility,both,1,EA,,7.05,7.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1985-03,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextrose: 10 Carton In 1 Package (0409-1775-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1775-40)",636,RC,0409-1775-10,NDC,,,facility,both,1,EA,,108.23,108.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1775-40,NDC,,,facility,both,1,EA,,33.83,33.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05)  / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)",636,RC,0409-1778-05,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1778-15,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1778-15,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 25 Vial, Single-Dose In 1 Carton (0409-1886-02)  / 5 Ml In 1 Vial, Single-Dose (0409-1886-22)",636,RC,0409-1886-02,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1886-22,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1886-22,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 10 Cartridge In 1 Carton (0409-1890-01)  / 1 Ml In 1 Cartridge (0409-1890-03),636,RC,0409-1890-01,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1890-03,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 10 Cartridge In 1 Carton (0409-1891-01)  / 1 Ml In 1 Cartridge (0409-1891-03),636,RC,0409-1891-01,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adenosine: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1932-02)  / 30 mL in 1 VIAL, SINGLE-DOSE",636,RC,0409-1932-02,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1985-03,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2016-05,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Tray (0409-2720-03)  / 30 Ml In 1 Vial, Multi-Dose (0409-2720-32)",636,RC,0409-2720-03,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2720-30,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3414-21,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3414-21,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3724-11,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3793-19,NDC,,,facility,both,1,EA,,6.13,6.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3795-19,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3815-11,NDC,,,facility,both,1,EA,,3.67,3.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3815-12)  / 10 Ml In 1 Vial, Glass (0409-3815-11)",636,RC,0409-3815-12,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4031-16,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4264-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4264-11,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4264-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-4276-16)",636,RC,0409-4276-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4276-17)",636,RC,0409-4276-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4276-16,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-4276-17,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3414-18,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3414-18,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 25 Vial, Single-Dose In 1 Tray (0409-3414-11)  / 2 Ml In 1 Vial, Single-Dose (0409-3414-21)",636,RC,0409-3414-11,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2720-30,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2723-30,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-2723-30,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1746-70,NDC,,,facility,both,1,EA,,22.51,22.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Acetate: 25 Vial In 1 Case (0409-3299-06)  / 100 Ml In 1 Vial (0409-3299-16),636,RC,0409-3299-06,NDC,,,facility,both,1,EA,,10.35,10.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3300-01,NDC,,,facility,both,1,EA,,4.35,4.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-3385-11,NDC,,,facility,both,1,EA,,5.53,5.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 25 Vial, Single-Dose In 1 Tray (0409-3414-01)  / 2 Ml In 1 Vial, Single-Dose (0409-3414-18)",636,RC,0409-3414-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 4 Bag In 1 Pouch (0338-0017-11)  / 50 Ml In 1 Bag,636,RC,0338-0017-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0125-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-0125-25)  / 20 Ml In 1 Vial, Multi-Dose (0409-0125-01)",636,RC,0409-0125-25,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Docetaxel: 1 Vial, Multi-Dose In 1 Carton (0409-0367-01)  / 4 Ml In 1 Vial, Multi-Dose",636,RC,0409-0367-01,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0829-11,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbocaine: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1041-30)  / 30 mL in 1 VIAL, SINGLE-DOSE",636,RC,0409-1041-30,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",636,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",636,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",636,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",636,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",636,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",636,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-1160-01)  / 50 Ml In 1 Vial, Multi-Dose (0409-1160-18)",636,RC,0409-1160-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-1160-01)  / 50 Ml In 1 Vial, Multi-Dose (0409-1160-18)",636,RC,0409-1160-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1162-18)",636,RC,0409-1162-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1162-18)",636,RC,0409-1162-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-0001-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam: 25 Vial, Single-Dose In 1 Carton (0409-0001-25)  / 2 Ml In 1 Vial, Single-Dose (0409-0001-01)",636,RC,0409-0001-25,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1162-18)",636,RC,0409-1162-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)",636,RC,0409-1162-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1283-17,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1283-17,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1283-17,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0409-1319-01)  / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,0409-1319-01,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-1323-05)  / 1 Syringe, Plastic In 1 Carton / 5 Ml In 1 Syringe, Plastic (0409-1323-15)",636,RC,0409-1323-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nalbuphine Hydrochloride: 10 Ampule In 1 Tray (0409-1463-01)  / 1 Ml In 1 Ampule (0409-1463-71),636,RC,0409-1463-01,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1463-71,NDC,,,facility,both,1,EA,,5.89,5.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Marcaine: 1 Vial, Multi-Dose In 1 Carton (0409-1610-50)  / 50 Ml In 1 Vial, Multi-Dose",636,RC,0409-1610-50,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1626-21,NDC,,,facility,both,1,EA,,8.15,8.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1630-15,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1630-15,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Chloride: 10 Carton In 1 Container (0409-1631-10)  / 1 Syringe, Plastic In 1 Carton (0409-1631-40)  / 10 Ml In 1 Syringe, Plastic",636,RC,0409-1631-10,NDC,,,facility,both,1,EA,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1632-21,NDC,,,facility,both,1,EA,,10.7,10.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)",636,RC,0409-1162-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)",636,RC,0409-1162-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)",636,RC,0409-1162-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1162-18,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1162-18,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)",636,RC,0409-1165-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-30)  / 30 Ml In 1 Vial, Single-Dose (0409-1746-71)",636,RC,0409-1746-30,NDC,,,facility,both,1,EA,,11.89,11.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1165-18,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1207-13,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1215-21,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1273-03,NDC,,,facility,both,1,EA,,21.51,21.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1273-03,NDC,,,facility,both,1,EA,,20.21,20.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diazepam: 10 Cartridge In 1 Carton (0409-1273-32)  / 2 Ml In 1 Cartridge (0409-1273-03),636,RC,0409-1273-32,NDC,,,facility,both,1,EA,,21.51,21.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fentanyl Citrate: 10 CARTRIDGE in 1 CARTON (0409-1276-32)  / 2 mL in 1 CARTRIDGE (0409-1276-03) ,636,RC,0409-1276-32,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9729-01,NDC,,,facility,both,1,EA,,22.6,22.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9746-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9784-01,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9786-01,NDC,,,facility,both,1,EA,,7.46,7.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9856-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9856-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9875-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 25 Vial In 1 Box (0143-9875-25)  / 3 Ml In 1 Vial (0143-9875-01),636,RC,0143-9875-25,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 25 Vial In 1 Box (0143-9875-25)  / 3 Ml In 1 Vial (0143-9875-01),636,RC,0143-9875-25,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 3 Ml In 1 Vial (0143-9924-90),636,RC,0143-9924-90,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefazolin: 3 Ml In 1 Vial (0143-9924-90),636,RC,0143-9924-90,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9983-91,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9719-01,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irinotecan Hydrochloride: 5 Ml In 1 Vial, Glass (0143-9701-01)",636,RC,0143-9701-01,NDC,,,facility,both,1,EA,,5.05,5.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irinotecan Hydrochloride: 5 Ml In 1 Vial, Glass (0143-9701-01)",636,RC,0143-9701-01,NDC,,,facility,both,1,EA,,5.03,5.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Testosterone Cypionate: 1 Ml In 1 Vial (0143-9659-01),636,RC,0143-9659-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoprolol Tartrate: 10 Vial In 1 Carton (0143-9660-10)  / 5 Ml In 1 Vial (0143-9660-01),636,RC,0143-9660-10,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoprolol Tartrate: 10 Vial In 1 Carton (0143-9660-10)  / 5 Ml In 1 Vial (0143-9660-01),636,RC,0143-9660-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9673-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 25 Vial, Glass In 1 Carton (0143-9673-25)  / 5 Ml In 1 Vial, Glass (0143-9673-01)",636,RC,0143-9673-25,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9680-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9680-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9681-25)  / 2 Ml In 1 Vial (0143-9681-01),636,RC,0143-9681-25,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9681-25)  / 2 Ml In 1 Vial (0143-9681-01),636,RC,0143-9681-25,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9681-25)  / 2 Ml In 1 Vial (0143-9681-01),636,RC,0143-9681-25,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9682-25)  / 1 Ml In 1 Vial (0143-9682-01),636,RC,0143-9682-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9682-25)  / 1 Ml In 1 Vial (0143-9682-01),636,RC,0143-9682-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 25 Vial In 1 Carton (0143-9682-25)  / 1 Ml In 1 Vial (0143-9682-01),636,RC,0143-9682-25,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irinotecan Hydrochloride: 5 Ml In 1 Vial, Glass (0143-9701-01)",636,RC,0143-9701-01,NDC,,,facility,both,1,EA,,5.02,5.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 1 Vial In 1 Box, Unit-Dose (0143-9622-01)  / 20 Ml In 1 Vial",636,RC,0143-9622-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0517-00)",636,RC,0173-0517-00,NDC,,,facility,both,1,EA,,27.1,27.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0517-00)",636,RC,0173-0517-00,NDC,,,facility,both,1,EA,,27.43,27.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 1000 Ml In 1 Bag (0338-0017-04),636,RC,0338-0017-04,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nucala: 1 Vial In 1 Carton (0173-0881-01)  / 1 Ml In 1 Vial,636,RC,0173-0881-01,NDC,,,facility,both,1,EA,,60.06,60.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nucala: 1 Vial In 1 Carton (0173-0881-01)  / 1 Ml In 1 Vial,636,RC,0173-0881-01,NDC,,,facility,both,1,EA,,60.24,60.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial,636,RC,0169-1833-11,NDC,,,facility,both,1,EA,,3.32,3.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic",636,RC,0169-6339-10,NDC,,,facility,both,1,EA,,4.5,4.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass",636,RC,0169-7501-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass",636,RC,0169-7501-11,NDC,,,facility,both,1,EA,,3.5,3.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9139-01,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9139-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9139-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9139-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9141-01,NDC,,,facility,both,1,EA,,4.91,4.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9156-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0121-4759-05,NDC,,,facility,both,1,EA,,3.44,3.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 10 Vial, Glass In 1 Carton (0131-1810-67)  / 20 Ml In 1 Vial, Glass",636,RC,0131-1810-67,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9156-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9156-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9338-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9382-01,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9383-01,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01)  / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9387-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetazolamide: 1 Vial In 1 Box, Unit-Dose (0143-9503-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9503-01,NDC,,,facility,both,1,EA,,31.79,31.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9506-01,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9507-01,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9511-01)  / 25 Ml In 1 Vial",636,RC,0143-9511-01,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leucovorin Calcium: 1 Vial In 1 Box, Unit-Dose (0143-9553-01)  / 20 Ml In 1 Vial",636,RC,0143-9553-01,NDC,,,facility,both,1,EA,,4.26,4.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01)  / 1 Ml In 1 Vial,636,RC,0143-9564-01,NDC,,,facility,both,1,EA,,841.18,841.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01)  / 1 Ml In 1 Vial,636,RC,0143-9564-01,NDC,,,facility,both,1,EA,,776.52,776.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9575-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lidocaine: 10 Vial, Multi-Dose In 1 Package (0143-9575-10)  / 50 Ml In 1 Vial, Multi-Dose (0143-9575-01)",636,RC,0143-9575-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9335-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9334-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9334-01)",636,RC,0143-9334-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9156-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9161-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9162-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9162-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 10 Vial In 1 Package (0143-9162-10)  / 1025 Mg In 1 Vial (0143-9162-01),636,RC,0143-9162-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01)  / 10.25 G In 1 Vial, Pharmacy Bulk Package",636,RC,0143-9164-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01)  / 10.25 G In 1 Vial, Pharmacy Bulk Package",636,RC,0143-9164-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9184-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9210-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9273-01,NDC,,,facility,both,1,EA,,64.07,64.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9284-01,NDC,,,facility,both,1,EA,,7.89,7.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9330-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9331-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9332-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0143-9333-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9333-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9333-01)",636,RC,0143-9333-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00)  / 1000 Ml In 1 Container,636,RC,0264-7612-00,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7612-10)  / 500 Ml In 1 Container,636,RC,0264-7612-10,NDC,,,facility,both,1,EA,,5.07,5.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7616-00)  / 1000 Ml In 1 Container,636,RC,0264-7616-00,NDC,,,facility,both,1,EA,,7.84,7.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Dextrose: 12 Container In 1 Case (0264-7625-00)  / 1000 Ml In 1 Container,636,RC,0264-7625-00,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Container In 1 Case (0264-7750-00)  / 1000 Ml In 1 Container,636,RC,0264-7750-00,NDC,,,facility,both,1,EA,,3.24,3.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Container In 1 Case (0264-7750-07)  / 1000 Ml In 1 Container,636,RC,0264-7750-07,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 12 Container In 1 Case (0264-7750-07)  / 1000 Ml In 1 Container,636,RC,0264-7750-07,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lactated Ringers: 24 Container In 1 Case (0264-7750-10)  / 500 Ml In 1 Container,636,RC,0264-7750-10,NDC,,,facility,both,1,EA,,4.88,4.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00)  / 1000 Ml In 1 Container,636,RC,0264-7751-00,NDC,,,facility,both,1,EA,,5.79,5.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00)  / 1000 Ml In 1 Container,636,RC,0264-7751-00,NDC,,,facility,both,1,EA,,5.83,5.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-7800-00)  / 1000 Ml In 1 Container,636,RC,0264-7800-00,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-7800-09)  / 1000 Ml In 1 Container,636,RC,0264-7800-09,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00)  / 1000 Ml In 1 Container,636,RC,0264-7612-00,NDC,,,facility,both,1,EA,,5.88,5.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 6 Carton In 1 Case (0264-5535-32)  / 4 Container In 1 Carton / 100 Ml In 1 Container,636,RC,0264-5535-32,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-5802-00)  / 1000 Ml In 1 Container,636,RC,0264-5802-00,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-5802-00)  / 1000 Ml In 1 Container,636,RC,0264-5802-00,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container,636,RC,0264-5802-10,NDC,,,facility,both,1,EA,,3.87,3.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container,636,RC,0264-5802-10,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-5804-00)  / 1000 Ml In 1 Container,636,RC,0264-5804-00,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-50)  / 2000 Ml In 1 Container,636,RC,0264-7388-50,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Container In 1 Case (0264-7510-00)  / 1000 Ml In 1 Container,636,RC,0264-7510-00,NDC,,,facility,both,1,EA,,5.89,5.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7510-10)  / 500 Ml In 1 Container,636,RC,0264-7510-10,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7510-20)  / 250 Ml In 1 Container,636,RC,0264-7510-20,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 12 Container In 1 Case (0264-7520-00)  / 1000 Ml In 1 Container,636,RC,0264-7520-00,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7520-10)  / 500 Ml In 1 Container,636,RC,0264-7520-10,NDC,,,facility,both,1,EA,,3.7,3.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 24 Container In 1 Case (0264-7520-20)  / 250 Ml In 1 Container,636,RC,0264-7520-20,NDC,,,facility,both,1,EA,,5.4,5.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00)  / 1000 Ml In 1 Container,636,RC,0264-7610-00,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00)  / 1000 Ml In 1 Container,636,RC,0264-7610-00,NDC,,,facility,both,1,EA,,2.93,2.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Magnesium Sulfate In Dextrose: 24 Container In 1 Case (0264-4400-54)  / 100 Ml In 1 Container,636,RC,0264-4400-54,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container,636,RC,0264-7800-20,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fasenra: 1 Syringe, Glass In 1 Carton (0310-1730-30)  / 1 Ml In 1 Syringe, Glass",636,RC,0310-1730-30,NDC,,,facility,both,1,EA,,341.86,341.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fasenra: 1 Syringe, Glass In 1 Carton (0310-1730-30)  / 1 Ml In 1 Syringe, Glass",636,RC,0310-1730-30,NDC,,,facility,both,1,EA,,338.38,338.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0310-3200-01,NDC,,,facility,both,1,EA,,237.84,237.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,636,RC,0310-3200-01,NDC,,,facility,both,1,EA,,237.91,237.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Andexxa: 4 Vial, Single-Use In 1 Carton (0310-3200-04)  / 20 Ml In 1 Vial, Single-Use (0310-3200-01)",636,RC,0310-3200-04,NDC,,,facility,both,1,EA,,236.71,236.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Andexxa: 4 Vial, Single-Use In 1 Carton (0310-3200-04)  / 20 Ml In 1 Vial, Single-Use (0310-3200-01)",636,RC,0310-3200-04,NDC,,,facility,both,1,EA,,238.17,238.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,164.48,164.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,165.05,165.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,162.56,162.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,164.86,164.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,162.46,162.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 250 Ml In 1 Bag (0338-0017-02),636,RC,0338-0017-02,NDC,,,facility,both,1,EA,,2.9,2.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 500 Ml In 1 Bag (0338-0017-03),636,RC,0338-0017-03,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 500 Ml In 1 Bag (0338-0017-03),636,RC,0338-0017-03,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7800-10)  / 500 Ml In 1 Container,636,RC,0264-7800-10,NDC,,,facility,both,1,EA,,5.41,5.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container,636,RC,0264-7800-20,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container,636,RC,0264-7800-20,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 12 Container In 1 Case (0264-7802-00)  / 1000 Ml In 1 Container,636,RC,0264-7802-00,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 24 Container In 1 Case (0264-7805-10)  / 500 Ml In 1 Container,636,RC,0264-7805-10,NDC,,,facility,both,1,EA,,5.99,5.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride In Sodium Chloride: 12 Container In 1 Case (0264-7865-00)  / 1000 Ml In 1 Container,636,RC,0264-7865-00,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20)  / 250 Ml In 1 Container,636,RC,0264-9587-20,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20)  / 250 Ml In 1 Container,636,RC,0264-9587-20,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Kinevac: 10 Vial In 1 Package (0270-0556-15)  / 5 Ml In 1 Vial,636,RC,0270-0556-15,NDC,,,facility,both,1,EA,,84.28,84.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Kinevac: 10 Vial In 1 Package (0270-0556-15)  / 5 Ml In 1 Vial,636,RC,0270-0556-15,NDC,,,facility,both,1,EA,,91.98,91.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dysport: 1 Vial In 1 Carton (0299-5962-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0299-5962-30,NDC,,,facility,both,1,EA,,17.26,17.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 24 Container In 1 Case (0264-4100-90)  / 100 Ml In 1 Container,636,RC,0264-4100-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0674-01),636,RC,0185-0674-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0674-01),636,RC,0185-0674-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 500 Capsule In 1 Bottle (0185-0674-05),636,RC,0185-0674-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 500 Capsule In 1 Bottle (0185-0674-05),636,RC,0185-0674-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0676-01),636,RC,0185-0676-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 84 Container In 1 Case (0264-1510-31)  / 50 Ml In 1 Container,636,RC,0264-1510-31,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextrose: 64 Container In 1 Case (0264-1510-32)  / 100 Ml In 1 Container,636,RC,0264-1510-32,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container,636,RC,0264-1800-31,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container,636,RC,0264-1800-31,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container,636,RC,0264-1800-32,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container,636,RC,0264-1800-32,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Container In 1 Case (0264-2201-00)  / 1000 Ml In 1 Container,636,RC,0264-2201-00,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Chloride: 16 Container In 1 Case (0264-2201-10)  / 500 Ml In 1 Container,636,RC,0264-2201-10,NDC,,,facility,both,1,EA,,3.74,3.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
8 CONTAINER in 1 CASE (0264-2201-50)  / 2000 mL in 1 CONTAINER,636,RC,0264-2201-50,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
8 CONTAINER in 1 CASE (0264-2201-50)  / 2000 mL in 1 CONTAINER,636,RC,0264-2201-50,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1620-01)  / 200 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0259-1620-01,NDC,,,facility,both,1,EA,,10.02,10.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0259-1610-01,NDC,,,facility,both,1,EA,,9.82,9.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0259-1610-01,NDC,,,facility,both,1,EA,,9.87,9.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-098-09)",637,RC,33342-098-09,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-256-66)  / 10 Capsule In 1 Blister Pack,637,RC,33342-256-66,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66)  / 10 Capsule In 1 Blister Pack,637,RC,33342-258-66,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ketoconazole: 30 Tablet In 1 Bottle (35573-433-30),637,RC,35573-433-30,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (33342-063-10)",637,RC,33342-063-10,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-727-30)",637,RC,31722-727-30,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (31722-729-30),637,RC,31722-729-30,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Irbesartan: 30 Tablet In 1 Bottle (31722-730-30),637,RC,31722-730-30,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 20 Tablet, Film Coated In 1 Bottle (31722-749-20)",637,RC,31722-749-20,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (31722-820-30),637,RC,31722-820-30,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 30 Tablet, Film Coated In 1 Bottle (33342-062-07)",637,RC,33342-062-07,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04)  / 5.8 G In 1 Packet,637,RC,37000-024-04,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,27241-134-21,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Pouch In 1 Carton (27241-139-09)  / 1 Bottle In 1 Pouch / 60 Ml In 1 Bottle,637,RC,27241-139-09,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Entacapone: 100 Tablet In 1 Bottle (27241-049-10),637,RC,27241-049-10,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline: 50 Capsule In 1 Bottle (27808-233-01),637,RC,27808-233-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (27808-155-01)",637,RC,27808-155-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamotrigine: 60 Tablet In 1 Bottle, Plastic (29300-113-16)",637,RC,29300-113-16,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-700-90)",637,RC,31722-700-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-126-13)",637,RC,29300-126-13,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)",637,RC,31722-186-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zidovudine: 12 Bottle In 1 Case (31722-509-60)  / 60 Tablet In 1 Bottle,637,RC,31722-509-60,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (31722-530-01),637,RC,31722-530-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-630-31),637,RC,31722-630-31,NDC,,,facility,both,1,EA,,4.7,4.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-632-31),637,RC,31722-632-31,NDC,,,facility,both,1,EA,,4.7,4.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (31722-103-30)",637,RC,31722-103-30,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-131-01)",637,RC,29300-131-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-135-01)",637,RC,29300-135-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)",637,RC,29300-140-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-355-01)",637,RC,29300-355-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amiodarone Hydrochloride: 60 Tablet In 1 Bottle (29300-359-16),637,RC,29300-359-16,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-413-01)",637,RC,29300-413-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (31722-053-60)",637,RC,31722-053-60,NDC,,,facility,both,1,EA,,7.18,7.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-269-10)",637,RC,43547-269-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-273-10)",637,RC,43547-273-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 90 Tablet, Film Coated In 1 Bottle, Plastic (43547-276-09)",637,RC,43547-276-09,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 100 Tablet, Film Coated, Extended Release In 1 Bottle (43547-289-10)",637,RC,43547-289-10,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Tablet In 1 Bottle (43547-352-10),637,RC,43547-352-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,43386-194-90,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25)  / 25 Tablet In 1 Blister Pack,637,RC,42858-302-25,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 473 Ml In 1 Bottle, Plastic (42858-304-16)",637,RC,42858-304-16,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-399-10)",637,RC,43547-399-10,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetrabenazine: 112 Tablet In 1 Bottle (43598-394-67),637,RC,43598-394-67,NDC,,,facility,both,1,EA,,4.46,4.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,43598-446-71,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,43598-447-71,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,43598-448-71,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Albendazole: 2 Tablet, Film Coated In 1 Bottle (43598-452-02)",637,RC,43598-452-02,NDC,,,facility,both,1,EA,,57.83,57.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 30 Tablet In 1 Bottle (43598-372-30),637,RC,43598-372-30,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10),637,RC,43547-688-10,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ciprofloxacin: 100 Tablet In 1 Bottle (43547-689-10),637,RC,43547-689-10,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43598-036-01)",637,RC,43598-036-01,NDC,,,facility,both,1,EA,,8.73,8.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ssd Cream: 50 G In 1 Jar (43598-210-55),637,RC,43598-210-55,NDC,,,facility,both,1,EA,,15.35,15.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin And Dexamethasone: 1 Bottle, Dropper In 1 Carton (43598-326-75)  / 7.5 Ml In 1 Bottle, Dropper",637,RC,43598-326-75,NDC,,,facility,both,1,EA,,166.81,166.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)",637,RC,42858-302-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valsartan: 90 Tablet In 1 Bottle (42291-857-90),637,RC,42291-857-90,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (42291-923-01),637,RC,42291-923-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,42292-038-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rufinamide: 120 Tablet In 1 Bottle (42571-392-12),637,RC,42571-392-12,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,42291-495-11,NDC,,,facility,both,1,EA,,4.3,4.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Np Thyroid 15: 100 Tablet In 1 Bottle (42192-327-01),637,RC,42192-327-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),637,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)",637,RC,42192-608-06,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,42291-477-11,NDC,,,facility,both,1,EA,,4.34,4.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Irbesartan: 90 Tablet, Film Coated In 1 Bottle (42658-122-04)",637,RC,42658-122-04,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 100 Capsule In 1 Bottle (42806-714-01),637,RC,42806-714-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-001-01)",637,RC,42858-001-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10)  / 10 Tablet In 1 Blister Pack,637,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-002-01)",637,RC,42858-002-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-002-10)  / 10 Tablet In 1 Blister Pack,637,RC,42858-002-10,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-003-01)",637,RC,42858-003-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25)  / 25 Tablet In 1 Blister Pack,637,RC,42858-301-25,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (42806-423-01)",637,RC,42806-423-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ivermectin: 2 Blister Pack In 1 Carton (42799-806-01)  / 10 Tablet In 1 Blister Pack,637,RC,42799-806-01,NDC,,,facility,both,1,EA,,7.48,7.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Estradiol: 100 Tablet In 1 Bottle (42806-087-01),637,RC,42806-087-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Estradiol: 100 Tablet In 1 Bottle (42806-089-01),637,RC,42806-089-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,42806-266-98,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)",637,RC,42806-339-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Itraconazole: 30 Capsule, Coated Pellets In 1 Bottle (16714-743-02)",637,RC,16714-743-02,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine: 30 Tablet In 1 Bottle (16714-795-01),637,RC,16714-795-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine: 100 Tablet In 1 Bottle (16714-795-02),637,RC,16714-795-02,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sumatriptan: 1 Blister Pack In 1 Carton (16714-796-01)  / 9 Tablet In 1 Blister Pack,637,RC,16714-796-01,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01)  / 9 Tablet In 1 Blister Pack,637,RC,16714-797-01,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01),637,RC,16714-813-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 90 Tablet In 1 Bottle (16714-813-02),637,RC,16714-813-02,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-717-01)",637,RC,16714-717-01,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-682-02)",637,RC,16714-682-02,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-683-02)",637,RC,16714-683-02,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-693-01),637,RC,16714-693-01,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 30 Tablet In 1 Bottle (16714-694-01),637,RC,16714-694-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluconazole: 1 Bottle In 1 Carton (16714-696-01)  / 35 Ml In 1 Bottle,637,RC,16714-696-01,NDC,,,facility,both,1,EA,,4.81,4.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-697-03)",637,RC,16714-697-03,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-698-03)",637,RC,16714-698-03,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bicalutamide: 30 Tablet In 1 Bottle (16729-023-10),637,RC,16729-023-10,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-136-00)",637,RC,16729-136-00,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)",637,RC,16714-990-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Tablet, Film Coated In 1 Bottle (16729-145-01)",637,RC,16729-145-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrochlorothiazide: 100 Tablet In 1 Bottle (16729-184-01),637,RC,16729-184-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)",637,RC,16729-136-16,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)",637,RC,16714-989-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (16714-868-01)",637,RC,16714-868-01,NDC,,,facility,both,1,EA,,5.78,5.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobazam: 100 Tablet In 1 Bottle (16714-887-01),637,RC,16714-887-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Permethrin: 1 Tube In 1 Container (16714-897-01)  / 60 G In 1 Tube,637,RC,16714-897-01,NDC,,,facility,both,1,EA,,29.29,29.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (16714-950-01)",637,RC,16714-950-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (16714-980-02)",637,RC,16714-980-02,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-988-01)",637,RC,16714-988-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-257-01)",637,RC,16714-257-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 125 Ml In 1 Bottle (16714-294-02),637,RC,16714-294-02,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (16714-296-01)",637,RC,16714-296-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Capsule In 1 Bottle (16714-298-01),637,RC,16714-298-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (16714-354-01)",637,RC,16714-354-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 473 Ml In 1 Bottle, Plastic (16714-358-01)",637,RC,16714-358-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01),637,RC,16714-388-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Capsule In 1 Bottle (16714-299-03),637,RC,16714-299-03,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-141-01),637,RC,16714-141-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01),637,RC,16714-142-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-143-01),637,RC,16714-143-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aripiprazole: 30 Tablet In 1 Bottle (16714-144-01),637,RC,16714-144-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 60 Tablet In 1 Bottle (16714-197-01),637,RC,16714-197-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (16714-234-01)",637,RC,16714-234-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (16714-235-01)",637,RC,16714-235-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 100 Capsule In 1 Bottle (16714-388-02),637,RC,16714-388-02,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefadroxil: 75 Ml In 1 Bottle (16714-390-01),637,RC,16714-390-01,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02)  / 60 Ml In 1 Bottle, Plastic",637,RC,16714-601-02,NDC,,,facility,both,1,EA,,4.64,4.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-612-04)",637,RC,16714-612-04,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-613-04)",637,RC,16714-613-04,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)",637,RC,16714-621-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Capsule In 1 Bottle (16714-661-01),637,RC,16714-661-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 500 Capsule In 1 Bottle (16714-662-02),637,RC,16714-662-02,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Capsule In 1 Bottle (16714-663-01),637,RC,16714-663-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 100 Tablet In 1 Bottle (16714-590-01),637,RC,16714-590-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (16714-394-01)",637,RC,16714-394-01,NDC,,,facility,both,1,EA,,5.29,5.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefuroxime Axetil: 20 Tablet In 1 Bottle (16714-400-01),637,RC,16714-400-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (16714-439-01),637,RC,16714-439-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (16714-444-01),637,RC,16714-444-01,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (16714-477-01)",637,RC,16714-477-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clindamycin Palmitate Hydrochloride (Pediatric): 1 Bottle, Plastic In 1 Carton (16714-483-02)  / 100 Ml In 1 Bottle, Plastic",637,RC,16714-483-02,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pravastatin Sodium: 90 Tablet In 1 Bottle (16714-559-01),637,RC,16714-559-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Tablet In 1 Bottle (16714-576-02),637,RC,16714-576-02,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride (Xl): 90 Tablet, Extended Release In 1 Bottle, Plastic (24979-101-07)",637,RC,24979-101-07,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle, Plastic (24979-231-01)",637,RC,24979-231-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mephyton: 1 BOTTLE in 1 CARTON (25010-405-15)  / 100 TABLET in 1 BOTTLE,637,RC,25010-405-15,NDC,,,facility,both,1,EA,,21.55,21.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Tablet, Extended Release In 1 Bottle (24979-010-01)",637,RC,24979-010-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02)  / 5 Ml In 1 Bottle, Dropper",637,RC,24208-720-02,NDC,,,facility,both,1,EA,,77.47,77.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (24208-486-10)  / 10 Ml In 1 Bottle, Dropper",637,RC,24208-486-10,NDC,,,facility,both,1,EA,,41.42,41.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (21922-009-09)  / 100 G In 1 Tube,637,RC,21922-009-09,NDC,,,facility,both,1,EA,,17.64,17.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dermoplast Pain Relieving: 85 G In 1 Can (16864-680-03),637,RC,16864-680-03,NDC,,,facility,both,1,EA,,10.5,10.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tacrolimus: 1 Tube In 1 Carton (21922-011-05)  / 30 G In 1 Tube,637,RC,21922-011-05,NDC,,,facility,both,1,EA,,86.73,86.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 15 G In 1 Tube (21922-016-04)",637,RC,21922-016-04,NDC,,,facility,both,1,EA,,7.21,7.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-767-01),637,RC,23155-767-01,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,23155-512-11,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (21922-017-04)  / 15 G In 1 Tube,637,RC,21922-017-04,NDC,,,facility,both,1,EA,,7.24,7.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (21922-029-04)  / 15 G In 1 Tube,637,RC,21922-029-04,NDC,,,facility,both,1,EA,,43.81,43.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methimazole: 100 Tablet In 1 Bottle (23155-070-01),637,RC,23155-070-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nifedipine: 100 Capsule In 1 Bottle (23155-194-01),637,RC,23155-194-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,43598-580-01,NDC,,,facility,both,1,EA,,8.89,8.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xarelto: 60 Tablet, Film Coated In 1 Bottle (50458-577-60)",637,RC,50458-577-60,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50458-578-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50458-579-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50458-580-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 1 Bottle In 1 Carton (50474-670-66)  / 60 Tablet, Film Coated In 1 Bottle",637,RC,50474-670-66,NDC,,,facility,both,1,EA,,43.83,43.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 100 Blister Pack In 1 Carton (50474-770-09)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,50474-770-09,NDC,,,facility,both,1,EA,,44.1,44.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-759-11,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-812-11,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-816-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cipro: 1 Kit In 1 Kit (50419-777-01)  *  100 Ml In 1 Bottle, Glass *  100 Ml In 1 Bottle, Plastic",637,RC,50419-777-01,NDC,,,facility,both,1,EA,,17.67,17.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Risperdal: 30 Ml In 1 Bottle (50458-305-03),637,RC,50458-305-03,NDC,,,facility,both,1,EA,,5.35,5.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Norethindrone Acetate: 50 Tablet In 1 Bottle (50742-267-50),637,RC,50742-267-50,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-362-60)",637,RC,50742-362-60,NDC,,,facility,both,1,EA,,3.5,3.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-363-60)",637,RC,50742-363-60,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50742-505-01,NDC,,,facility,both,1,EA,,17.17,17.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Scopolamine: 24 Pouch In 1 Carton (50742-505-24)  / 1 Patch, Extended Release In 1 Pouch",637,RC,50742-505-24,NDC,,,facility,both,1,EA,,9.77,9.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (50742-615-01)",637,RC,50742-615-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-023-01,NDC,,,facility,both,1,EA,,3.94,3.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-024-01,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-058-01,NDC,,,facility,both,1,EA,,2.75,2.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (50742-261-03)",637,RC,50742-261-03,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30)  / 30 G In 1 Tube,637,RC,50484-010-30,NDC,,,facility,both,1,EA,,547.18,547.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tylenol Extra Strength: 10 Blister Pack In 1 Carton (50580-457-11)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,50580-457-11,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,50580-458-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"10 BLISTER PACK in 1 CARTON (50580-600-02)  / 10 TABLET, FILM COATED in 1 BLISTER PACK",637,RC,50580-600-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Briviact: 1 Bottle In 1 Carton (50474-770-66)  / 60 Tablet, Film Coated In 1 Bottle",637,RC,50474-770-66,NDC,,,facility,both,1,EA,,44.37,44.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-757-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-504-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-505-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-520-11,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-522-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-525-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-526-11,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-535-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-476-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-314-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-330-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-337-11,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-350-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-411-11,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-540-11,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-686-11,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-709-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-717-11,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-728-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-742-11,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyvinyl Alcohol: 15 Ml In 1 Bottle (50268-678-15),637,RC,50268-678-15,NDC,,,facility,both,1,EA,,15.71,15.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-563-11,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-574-11,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-585-11,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-595-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-597-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetazolamide: 100 Tablet In 1 Bottle (51672-4023-1),637,RC,51672-4023-1,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Warfarin Sodium: 100 Tablet In 1 Bottle (51672-4027-1),637,RC,51672-4027-1,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine: 1 Tube In 1 Carton (51672-3020-2)  / 30 G In 1 Tube,637,RC,51672-3020-2,NDC,,,facility,both,1,EA,,43.09,43.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4037-1),637,RC,51672-4037-1,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (51672-4111-1)",637,RC,51672-4111-1,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51672-2116-0,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ",637,RC,51079-991-20,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trikafta: 4 Blister Pack In 1 Carton (51167-331-01)  / 1 Kit In 1 Blister Pack *  14 Tablet, Film Coated In 1 Blister Pack (51167-431-14)  *  7 Tablet, Film Coated In 1 Blister Pack (51167-531-07)",637,RC,51167-331-01,NDC,,,facility,both,1,EA,,584.9,584.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (51407-449-01)",637,RC,51407-449-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6)  / 45 G In 1 Tube, With Applicator",637,RC,51672-2035-6,NDC,,,facility,both,1,EA,,5.91,5.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-2)  / 30 G In 1 Tube,637,RC,51672-2080-2,NDC,,,facility,both,1,EA,,13.76,13.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51672-2114-0,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51672-2115-0,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbamazepine: 100 Tablet, Extended Release In 1 Bottle (51672-4124-1)",637,RC,51672-4124-1,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-986-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
240 mL in 1 BOTTLE (52380-1905-8) ,637,RC,52380-1905-8,NDC,,,facility,both,1,EA,,2.32,2.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Eprontia: 473 Ml In 1 Bottle (52652-9001-1),637,RC,52652-9001-1,NDC,,,facility,both,1,EA,,7.32,7.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Tablet In 1 Bottle (52817-319-10),637,RC,52817-319-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (52817-330-50)",637,RC,52817-330-50,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (52817-332-10)",637,RC,52817-332-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Petroleum: 1 Tube In 1 Box (53329-068-01)  / 28.4 G In 1 Tube,637,RC,53329-068-01,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (53489-118-02)",637,RC,53489-118-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Theo-24: 100 Capsule, Extended Release In 1 Bottle (52244-100-10)",637,RC,52244-100-10,NDC,,,facility,both,1,EA,,7,7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4245-1),637,RC,51672-4245-1,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (51991-349-06)",637,RC,51991-349-06,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)",637,RC,51991-877-33,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 60 Tablet In 1 Bottle (51672-4132-4),637,RC,51672-4132-4,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-985-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-285-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-286-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-436-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-437-01,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-444-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-453-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-458-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-284-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-087-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-103-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-118-01,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-141-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-169-01,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-205-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-246-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-255-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-801-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-821-01,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-921-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-922-01,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-923-01,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-978-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-766-01,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-753-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-599-01,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-684-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-690-01,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,51079-734-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60)  / 60 G In 1 Tube,637,RC,50268-195-60,NDC,,,facility,both,1,EA,,6.2,6.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen Pain Reliever Fever Reducer: 100 Blister Pack In 1 Carton (45802-730-33)  / 1 Suppository In 1 Blister Pack,637,RC,45802-730-33,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,45802-732-00,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,45802-873-03,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Polystyrene Sulfonate: 10 Bottle, Unit-Dose In 1 Carton (46287-006-60)  / 60 Ml In 1 Bottle, Unit-Dose",637,RC,46287-006-60,NDC,,,facility,both,1,EA,,43.63,43.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00),637,RC,45802-730-00,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (47335-237-83)",637,RC,47335-237-83,NDC,,,facility,both,1,EA,,69.41,69.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clindamycin Phosphate: 1 Bottle, With Applicator In 1 Carton (45802-562-02)  / 60 Ml In 1 Bottle, With Applicator",637,RC,45802-562-02,NDC,,,facility,both,1,EA,,44.34,44.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Acetaminophen: 1 Bottle In 1 Carton (45802-201-26)  / 118 Ml In 1 Bottle,637,RC,45802-201-26,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 1 Tube In 1 Carton (45802-276-03)  / 28 G In 1 Tube,637,RC,45802-276-03,NDC,,,facility,both,1,EA,,3.01,3.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Betamethasone Dipropionate: 1 Tube In 1 Carton (45802-376-35)  / 15 G In 1 Tube,637,RC,45802-376-35,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21)  / 89 Ml In 1 Bottle,637,RC,45802-433-21,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 1 Tube In 1 Carton (45802-438-03)  / 28 G In 1 Tube,637,RC,45802-438-03,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,48433-219-05,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mineral Oil: 30 Ml In 1 Cup, Unit-Dose (48433-202-30)",637,RC,48433-202-30,NDC,,,facility,both,1,EA,,3.21,3.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,47781-356-11,NDC,,,facility,both,1,EA,,5.77,5.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,47781-357-11,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,47781-358-11,NDC,,,facility,both,1,EA,,8.9,8.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (47781-468-13)  / 10 Capsule In 1 Blister Pack,637,RC,47781-468-13,NDC,,,facility,both,1,EA,,16.92,16.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Disulfiram: 30 Tablet In 1 Bottle, Plastic (47781-607-30)",637,RC,47781-607-30,NDC,,,facility,both,1,EA,,3.69,3.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-643-90),637,RC,47781-643-90,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-065-35)  / 15 G In 1 Tube,637,RC,45802-065-35,NDC,,,facility,both,1,EA,,10.56,10.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diclofenac Sodium: 1 Tube In 1 Carton (43598-977-10)  / 100 G In 1 Tube,637,RC,43598-977-10,NDC,,,facility,both,1,EA,,17.64,17.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (43975-322-03)",637,RC,43975-322-03,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (45802-048-35)  / 15 G In 1 Tube,637,RC,45802-048-35,NDC,,,facility,both,1,EA,,13.3,13.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-35)  / 15 G In 1 Tube,637,RC,45802-054-35,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 454 G In 1 Jar (45802-055-05),637,RC,45802-055-05,NDC,,,facility,both,1,EA,,37.87,37.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (45802-059-35)  / 15 G In 1 Tube,637,RC,45802-059-35,NDC,,,facility,both,1,EA,,21.89,21.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,45802-060-00,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-063-35)  / 15 G In 1 Tube,637,RC,45802-063-35,NDC,,,facility,both,1,EA,,6.4,6.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-152-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-131-11,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-168-11,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-169-11,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-189-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-098-11,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-037-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-074-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-087-11,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-088-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,50268-089-11,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)",637,RC,49702-231-13,NDC,,,facility,both,1,EA,,232.99,232.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (49884-049-01)",637,RC,49884-049-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-156-76)",637,RC,49884-156-76,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,49884-311-52,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,49884-315-52,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 7 Blister Pack In 1 Carton (49884-315-91)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack (49884-315-52)",637,RC,49884-315-91,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,49884-321-52,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)",637,RC,49702-228-13,NDC,,,facility,both,1,EA,,138.54,138.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sunmark Childrens Pain And Fever: 1 Bottle In 1 Carton (49348-119-34)  / 118 Ml In 1 Bottle,637,RC,49348-119-34,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sunmark Nicotine: 110 Blister Pack In 1 Carton (49348-573-36)  / 1 Gum, Chewing In 1 Blister Pack",637,RC,49348-573-36,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sunmark stay awake: 16 BLISTER PACK in 1 CARTON (49348-771-03)  / 1 TABLET in 1 BLISTER PACK,637,RC,49348-771-03,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Athletes Foot: 1 Tube In 1 Carton (49348-790-72)  / 30 G In 1 Tube,637,RC,49348-790-72,NDC,,,facility,both,1,EA,,12.76,12.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Senna Time: 1000 Tablet, Coated In 1 Bottle, Plastic (49483-080-10)",637,RC,49483-080-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-327-01),637,RC,50111-327-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-194-60)",637,RC,50228-194-60,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (50228-232-01),637,RC,50228-232-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (50228-459-01),637,RC,50228-459-01,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-193-60)",637,RC,50228-193-60,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-328-01),637,RC,50111-328-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Tablet In 1 Bottle (50111-334-01),637,RC,50111-334-01,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-398-01),637,RC,50111-398-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 500 Tablet In 1 Bottle (50111-560-02),637,RC,50111-560-02,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (50111-915-01),637,RC,50111-915-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Torsemide: 100 Tablet In 1 Bottle (50111-918-01),637,RC,50111-918-01,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (50228-158-01),637,RC,50228-158-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-192-60)",637,RC,50228-192-60,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82)  / 1 Capsule In 1 Blister Pack,637,RC,0597-0360-82,NDC,,,facility,both,1,EA,,5.67,5.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0603-1880-10,NDC,,,facility,both,1,EA,,4.14,4.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Baclofen: 100 Tablet In 1 Bottle, Plastic (0603-2406-21)",637,RC,0603-2406-21,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Benztropine Mesylate: 100 Tablet In 1 Bottle, Plastic (0603-2434-21)",637,RC,0603-2434-21,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0603-3078-21) ",637,RC,0603-3078-21,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 60 Blister Pack In 1 Carton (0597-0355-56)  / 1 Capsule In 1 Blister Pack,637,RC,0597-0355-56,NDC,,,facility,both,1,EA,,5.68,5.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0574-0107-70)",637,RC,0574-0107-70,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Actidose Aqua: 240 Ml In 1 Tube (0574-0521-76),637,RC,0574-0521-76,NDC,,,facility,both,1,EA,,25.21,25.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aspirin: 12 Packet In 1 Carton (0574-7034-12)  / 1 Suppository In 1 Packet,637,RC,0574-7034-12,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12)  / 1 Suppository In 1 Blister Pack,637,RC,0574-7050-12,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bisacodyl: 50 Blister Pack In 1 Carton (0574-7050-50)  / 1 Suppository In 1 Blister Pack,637,RC,0574-7050-50,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ready-To-Use: 1 Bottle In 1 Carton (0536-7415-51)  / 133 Ml In 1 Bottle,637,RC,0536-7415-51,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0033-02),637,RC,0555-0033-02,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0159-02),637,RC,0555-0159-02,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0779-02),637,RC,0555-0779-02,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrochlorothiazide: 100 Capsule, Gelatin Coated In 1 Bottle (0591-0347-01)",637,RC,0591-0347-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrochlorothiazide: 500 Capsule, Gelatin Coated In 1 Bottle (0591-0347-05)",637,RC,0591-0347-05,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproic: 100 Capsule, Liquid Filled In 1 Bottle (0591-4012-01)",637,RC,0591-4012-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Allopurinol: 100 Tablet In 1 Bottle, Plastic (0591-5543-01)",637,RC,0591-5543-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pradaxa: 10 Blister Pack In 1 Carton (0597-0108-60)  / 6 Capsule In 1 Blister Pack,637,RC,0597-0108-60,NDC,,,facility,both,1,EA,,5.68,5.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0597-0152-37,NDC,,,facility,both,1,EA,,25,25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0597-0153-37,NDC,,,facility,both,1,EA,,25.03,25.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Bottle (0591-3659-30)",637,RC,0591-3659-30,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)",637,RC,0591-3541-60,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Guanfacine: 100 Tablet In 1 Bottle, Plastic (0591-0444-01)",637,RC,0591-0444-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0605-01)",637,RC,0591-0605-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0607-01)",637,RC,0591-0607-01,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desmopressin Acetate: 100 TABLET in 1 BOTTLE, PLASTIC (0591-2464-01) ",637,RC,0591-2464-01,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Colchicine: 100 Tablet, Film Coated In 1 Bottle (0591-2562-01)",637,RC,0591-2562-01,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0591-3525-11,NDC,,,facility,both,1,EA,,2.73,2.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxybutynin Chloride: 100 Tablet In 1 Bottle (0832-0038-00),637,RC,0832-0038-00,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0832-0038-89,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0832-1211-89,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0832-1213-89,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5439-20)",637,RC,0781-5439-20,NDC,,,facility,both,1,EA,,9.04,9.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5654-01)",637,RC,0781-5654-01,NDC,,,facility,both,1,EA,,5.43,5.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5669-01)",637,RC,0781-5669-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1487-01)",637,RC,0781-1487-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1488-01)",637,RC,0781-1488-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1556-01),637,RC,0781-1556-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 40 Tablet, Multilayer, Extended Release In 1 Bottle (0781-1943-39)",637,RC,0781-1943-39,NDC,,,facility,both,1,EA,,9.18,9.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1077-01),637,RC,0781-1077-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0713-0118-06,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nystatin: 1 Tube In 1 Carton (0713-0678-15)  / 15 G In 1 Tube,637,RC,0713-0678-15,NDC,,,facility,both,1,EA,,11.45,11.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01),637,RC,0781-1061-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (0832-7122-11)",637,RC,0832-7122-11,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicotine: 14 Pouch In 1 Carton (0536-5896-88)  / 1 H In 1 Pouch,637,RC,0536-5896-88,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 1 Bottle, Plastic In 1 Carton (0527-1948-66)  / 100 Ml In 1 Bottle, Plastic",637,RC,0527-1948-66,NDC,,,facility,both,1,EA,,41.31,41.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0521-2345-00,NDC,,,facility,both,1,EA,,8.66,8.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (0527-4591-13)  / 10 Capsule In 1 Blister Pack,637,RC,0527-4591-13,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oseltamivir Phosphate: 1 Bottle, Plastic In 1 Carton (0527-5137-62)  / 60 Ml In 1 Bottle, Plastic",637,RC,0527-5137-62,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sodium Bicarbonate Antacid: 1000 Tablet In 1 Bottle (0536-1047-10),637,RC,0536-1047-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 90 Tablet In 1 Bottle (0527-3281-46),637,RC,0527-3281-46,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0521-2311-00,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Maxi Nicotine: 3 Bottle, Plastic In 1 Box (0536-1338-09)  / 24 Lozenge In 1 Bottle, Plastic",637,RC,0536-1338-09,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Nicotine Polacrilex Gum, Mint Flavor: 11 Blister Pack In 1 Carton (0536-1362-23)  / 10 Gum, Chewing In 1 Blister Pack",637,RC,0536-1362-23,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0536-1362-25,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Regular Strength Acetaminophen: 1000 Tablet In 1 Bottle, Plastic (0536-1327-10)",637,RC,0536-1327-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate 2% Cream Antifungal: 1 Tube In 1 Box (0536-1375-75)  / 28.3 G In 1 Tube,637,RC,0536-1375-75,NDC,,,facility,both,1,EA,,4.59,4.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94)  / 15 Ml In 1 Bottle, Dropper",637,RC,0536-1408-94,NDC,,,facility,both,1,EA,,9.4,9.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Capsaicin: 1 Tube In 1 Carton (0536-2525-25)  / 60 G In 1 Tube,637,RC,0536-2525-25,NDC,,,facility,both,1,EA,,10.12,10.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0536-3029-25,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nicotine: 14 Pouch In 1 Carton (0536-5895-88)  / 1 H In 1 Pouch,637,RC,0536-5895-88,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Regular Strength Antacid/Antigas: 355 Ml In 1 Bottle (0536-1317-83),637,RC,0536-1317-83,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Carbonate 10 Gr (648 Mg) (Antacid): 1000 Tablet In 1 Bottle, Plastic (0536-1206-10)",637,RC,0536-1206-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)",637,RC,0536-1228-58,NDC,,,facility,both,1,EA,,4.56,4.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Regular Strength: 1 Bottle, Plastic In 1 Carton (0536-1232-01)  / 100 Tablet, Delayed Release In 1 Bottle, Plastic",637,RC,0536-1232-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose: 1 Bottle, Plastic In 1 Carton (0536-1234-41)  / 120 Tablet, Delayed Release In 1 Bottle, Plastic",637,RC,0536-1234-41,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)",637,RC,0536-1286-36,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Myrbetriq: 1 Bottle In 1 Carton (0469-2601-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle",637,RC,0469-2601-30,NDC,,,facility,both,1,EA,,27.74,27.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Myrbetriq: 1 Bottle In 1 Carton (0469-2602-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle",637,RC,0469-2602-30,NDC,,,facility,both,1,EA,,27.73,27.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 TUBE in 1 CARTON (0472-0400-15)  / 15 g in 1 TUBE,637,RC,0472-0400-15,NDC,,,facility,both,1,EA,,185.96,185.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Antifungal: 1 TUBE in 1 CARTON (0472-0735-56)  / 28 g in 1 TUBE,637,RC,0472-0735-56,NDC,,,facility,both,1,EA,,4.24,4.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate: 3 Suppository In 1 Carton (0472-1738-03),637,RC,0472-1738-03,NDC,,,facility,both,1,EA,,18.68,18.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Viibryd: 30 Tablet In 1 Bottle (0456-1120-30),637,RC,0456-1120-30,NDC,,,facility,both,1,EA,,21.3,21.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1201-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",637,RC,0456-1201-30,NDC,,,facility,both,1,EA,,33.67,33.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1202-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",637,RC,0456-1202-30,NDC,,,facility,both,1,EA,,33.13,33.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linzess: 1 Bottle In 1 Carton (0456-1203-30)  / 30 Capsule, Gelatin Coated In 1 Bottle",637,RC,0456-1203-30,NDC,,,facility,both,1,EA,,33.74,33.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Blister Pack In 1 Carton (0904-7511-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7511-61,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Blister Pack In 1 Carton (0904-7728-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7728-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7914-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cetirizine: 100 Blister Pack In 1 Carton (0904-7510-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7510-61,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7246-68)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7246-68,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7247-68)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7247-68,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7252-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7245-68)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7245-68,NDC,,,facility,both,1,EA,,2.97,2.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxcarbazepine: 100 Blister Pack In 1 Carton (0904-7263-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7263-61,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0904-7265-41,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0904-7276-41,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sennosides: 1000 Tablet, Film Coated In 1 Bottle (0904-7252-80)",637,RC,0904-7252-80,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7187-61,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 50 Blister Pack In 1 Carton (0904-7193-06)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7193-06,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7219-61)  / 1 Capsule, Extended Release In 1 Blister Pack",637,RC,0904-7219-61,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7227-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7243-61,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0904-7279-66,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7383-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (0904-7418-44)",637,RC,0904-7418-44,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7442-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7442-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Acetaminophen: 1 Bottle In 1 Carton (0904-7445-20)  / 118 Ml In 1 Bottle,637,RC,0904-7445-20,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7501-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7501-61,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7505-61)  / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-7505-61,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-7509-30)  / 1 Tablet, Chewable In 1 Blister Pack",637,RC,0904-7509-30,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7375-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7375-61,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benztropine Mesylate: 100 Blister Pack In 1 Carton (0904-7288-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7288-61,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7293-61)  / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-7293-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7305-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7308-61,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 50 Blister Pack In 1 Carton (0904-7350-06)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7350-06,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7360-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7360-61,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7362-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7362-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7363-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-009-01)",637,RC,13668-009-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (13668-104-01)",637,RC,13668-104-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (13668-105-01)",637,RC,13668-105-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (13668-190-30)",637,RC,13668-190-30,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tadalafil: 30 Tablet In 1 Bottle (13668-581-30),637,RC,13668-581-30,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-706-10)",637,RC,13811-706-10,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-707-10)",637,RC,13811-707-10,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Mupirocin: 1 Tube In 1 Carton (16714-055-01)  / 15 G In 1 Tube,637,RC,16714-055-01,NDC,,,facility,both,1,EA,,204.57,204.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (16714-081-10),637,RC,16714-081-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (16714-110-01)",637,RC,16714-110-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levocarnitine: 9 Blister Pack In 1 Carton (16571-762-09)  / 10 Tablet In 1 Blister Pack,637,RC,16571-762-09,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),637,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 100 Tablet In 1 Bottle (16571-668-01),637,RC,16571-668-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamylon: 1 Tube In 1 Carton (16571-723-60)  / 56.7 G In 1 Tube,637,RC,16571-723-60,NDC,,,facility,both,1,EA,,131.9,131.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)",637,RC,10572-302-01,NDC,,,facility,both,1,EA,,35.28,35.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (10702-100-01),637,RC,10702-100-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin Chloride: 100 Tablet In 1 Bottle, Plastic (10702-201-01)",637,RC,10702-201-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ursodiol: 100 Capsule In 1 Bottle (10702-237-01),637,RC,10702-237-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Critic Aid Clear Af: 57 G In 1 Tube (11701-067-23),637,RC,11701-067-23,NDC,,,facility,both,1,EA,,12.37,12.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Grafco Applicator 15 Cm: 100 Stick In 1 Tube (12165-100-01),637,RC,12165-100-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silver Nitrate Applicators: 100 Applicator In 1 Vial (12870-0001-2)  / 100 Mg In 1 Applicator,637,RC,12870-0001-2,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)",637,RC,13107-001-30,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 90 Tablet In 1 Bottle (10135-787-90),637,RC,10135-787-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 100 Tablet In 1 Bottle (13107-014-01),637,RC,13107-014-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-031-34)",637,RC,13107-031-34,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 30 Tablet, Film Coated In 1 Bottle (13107-154-30)",637,RC,13107-154-30,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (13517-628-01)",637,RC,13517-628-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0832-7123-89,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61)  / 10 Capsule, Liquid Filled In 1 Blister Pack",637,RC,0904-7183-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Major Regular Strength Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0904-6412-92)",637,RC,0904-6412-92,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6418-61,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6426-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61)  / 10 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6407-61,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Temazepam: 30 Blister Pack In 1 Carton (0904-6436-04)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6436-04,NDC,,,facility,both,1,EA,,4.91,4.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel: 20 Blister Pack In 1 Carton (0904-6467-10)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6467-10,NDC,,,facility,both,1,EA,,9.52,9.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6475-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Donepezil Hydrochloride: 100 Blister Pack In 1 Carton (0904-6477-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6477-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 100 Blister Pack In 1 Carton (0904-6377-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6377-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6322-61,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6352-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6352-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6353-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6353-61,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6373-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6373-61,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6374-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6374-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6558-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6558-61,NDC,,,facility,both,1,EA,,2.26,2.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valacyclovir Hydrochloride: 100 Blister Pack In 1 Carton (0904-6565-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6565-61,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61)  / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6570-61,NDC,,,facility,both,1,EA,,2.24,2.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenobarbital: 100 Blister Pack In 1 Carton (0904-6575-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6575-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6637-61,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6638-61,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6557-61,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Blister Pack In 1 Carton (0904-6502-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6502-61,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6503-61,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6505-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6505-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6506-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6506-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 100 Blister Pack In 1 Carton (0904-6519-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6519-61,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propranolol Hydrochloride: 100 Blister Pack In 1 Carton (0904-6550-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6550-61,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 30 Blister Pack In 1 Carton (0904-6553-04)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6553-04,NDC,,,facility,both,1,EA,,6.73,6.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 50 Blister Pack In 1 Carton (0904-6322-06)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6322-06,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-5522-61,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Heartburn Relief Original Strength: 30 Blister Pack In 1 Carton (0904-5529-87)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-5529-87,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-5677-61,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Blister Pack In 1 Carton (0904-5784-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-5784-61,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-5789-61,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 500 Tablet In 1 Bottle (0904-5853-40),637,RC,0904-5853-40,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0832-7124-01)  / 1 Tablet, Delayed Release In 1 Blister Pack (0832-7124-89)",637,RC,0832-7124-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oil: 473 Ml In 1 Bottle, Plastic (0869-0831-43)",637,RC,0869-0831-43,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bismatrol: 236 mL in 1 BOTTLE (0904-1313-09) ,637,RC,0904-1313-09,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)",637,RC,0904-2533-21,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-2725-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0904-3865-75,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sudogest: 1 Bottle, Plastic In 1 Carton (0904-5053-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic",637,RC,0904-5053-59,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (0904-5853-60),637,RC,0904-5853-60,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6084-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbamazepine: 100 Blister Pack In 1 Carton (0904-6172-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6172-61,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-6238-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6238-61,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ziprasidone: 80 Blister Pack In 1 Carton (0904-6269-45)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6269-45,NDC,,,facility,both,1,EA,,3.14,3.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ziprasidone: 80 Blister Pack In 1 Carton (0904-6272-45)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6272-45,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6292-61,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)",637,RC,0904-6300-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sore Throat Cherry: 177 Ml In 1 Bottle, Spray (0904-6305-21)",637,RC,0904-6305-21,NDC,,,facility,both,1,EA,,3.47,3.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6640-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61)  / 1 Tablet In 1 Blister Pack",637,RC,0904-5891-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61)  / 1 Tablet In 1 Blister Pack",637,RC,0904-5892-61,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"INFANTS GAS RELIEF: 1 BOTTLE, DROPPER in 1 CARTON (0904-5894-30)  / 30 mL in 1 BOTTLE, DROPPER",637,RC,0904-5894-30,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-5921-61,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-5959-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (0904-6007-60),637,RC,0904-6007-60,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6007-61,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Blister Pack In 1 Carton (0904-6008-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6008-61,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6082-61,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6642-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7007-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7008-61,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7001-61,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-7027-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7027-61,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naltrexone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7036-04)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7036-04,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Allopurinol: 100 Blister Pack In 1 Carton (0904-7041-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7041-61,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxepin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7053-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7053-61,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-7000-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7000-61,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6951-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6951-61,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6952-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6952-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6954-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6954-61,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6955-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6955-61,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6988-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6988-61,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 100 Blister Pack In 1 Carton (0904-6992-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6992-61,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7083-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7083-61,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6950-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6950-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61)  / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-7084-61,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7137-61,NDC,,,facility,both,1,EA,,3.21,3.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 100 Blister Pack In 1 Carton (0904-7153-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7153-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7156-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7162-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Blister Pack In 1 Carton (0904-7177-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7177-61,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 100 Blister Pack In 1 Carton (0904-7178-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7178-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metronidazole: 100 Blister Pack In 1 Carton (0904-7126-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7126-61,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pioglitazone: 100 Blister Pack In 1 Carton (0904-7090-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7090-61,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Blister Pack In 1 Carton (0904-7106-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7106-61,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 50 Blister Pack In 1 Carton (0904-7119-06)  / 1 Capsule In 1 Blister Pack,637,RC,0904-7119-06,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7122-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-7122-61,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7123-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7123-61,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7124-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6949-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6949-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61)  / 10 Tablet In 1 Blister Pack",637,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Acetaminophen: 1 Bottle In 1 Carton (0904-6766-20)  / 118 Ml In 1 Bottle,637,RC,0904-6766-20,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Childrens Loratadine Oral: 1 Bottle In 1 Carton (0904-6767-20)  / 120 Ml In 1 Bottle,637,RC,0904-6767-20,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),637,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6778-61)  / 1 Tablet, Coated In 1 Blister Pack",637,RC,0904-6778-61,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6782-61,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-6794-30)  / 1 Tablet, Chewable In 1 Blister Pack",637,RC,0904-6794-30,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61)  / 10 Tablet In 1 Blister Pack",637,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39)  / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6718-39,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6665-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6666-61,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61)  / 1 Capsule In 1 Blister Pack,637,RC,0904-6667-61,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 100 Blister Pack In 1 Carton (0904-6704-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6704-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6709-61,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)",637,RC,0904-6794-80,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61)  / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6860-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6861-61)  / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6861-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 90 Blister Pack In 1 Carton (0904-6861-90)  / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6861-90,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6868-61,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pseudoephedrine Hydrochloride: 5 Blister Pack In 1 Box (0904-6907-06)  / 10 Tablet In 1 Blister Pack,637,RC,0904-6907-06,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6927-61,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86),637,RC,0904-6931-86,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6797-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6798-61,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6799-61,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6817-06)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6817-06,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0904-6828-05,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycodone Hydrochloride: 4 Tray In 1 Carton (0904-6828-94)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0904-6828-05)",637,RC,0904-6828-94,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 50 Blister Pack In 1 Carton (0904-6830-06)  / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6830-06,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61)  / 1 Tablet In 1 Blister Pack,637,RC,0904-6852-61,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Folic Acid: 100 Tablet In 1 Bottle (53746-361-01),637,RC,53746-361-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-859-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-862-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-844-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-964-95,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-968-11,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-975-11,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-808-11,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-655-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-697-11,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-698-11,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-728-11,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tizanidine: 30 Blister Pack In 1 Box, Unit-Dose (68084-775-25)  / 1 Tablet In 1 Blister Pack (68084-775-95)",637,RC,68084-775-25,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-776-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-782-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-988-33,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-001-59,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-756-59,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-762-59,NDC,,,facility,both,1,EA,,8.14,8.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Famotidine: 50 Ml In 1 Bottle (68180-150-01),637,RC,68180-150-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-152-06)",637,RC,68180-152-06,NDC,,,facility,both,1,EA,,19.17,19.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride Xl: 90 Tablet, Extended Release In 1 Bottle (68180-319-09)",637,RC,68180-319-09,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cephalexin: 100 Ml In 1 Bottle (68180-441-01),637,RC,68180-441-01,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine Succinate: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-593-06)",637,RC,68180-593-06,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline: 60 Ml In 1 Bottle (68180-657-01),637,RC,68180-657-01,NDC,,,facility,both,1,EA,,6.64,6.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-750-59,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-004-59,NDC,,,facility,both,1,EA,,4.03,4.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-048-59,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-129-59,NDC,,,facility,both,1,EA,,4.8,4.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-330-59,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Acetaminophen: 3 Tray In 1 Case (68094-330-62)  / 10 Cup, Unit-Dose In 1 Tray / 10.15 Ml In 1 Cup, Unit-Dose (68094-330-59)",637,RC,68094-330-62,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-494-59,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68094-600-59,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-654-11,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-270-11,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-272-11,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-280-11,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-291-11,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-299-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-281-11,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-214-11,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-104-11,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-120-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-202-11,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-204-11,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Benzonatate: 10 Blister Pack In 1 Carton (68084-214-01)  / 10 Capsule In 1 Blister Pack (68084-214-11),637,RC,68084-214-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-309-11,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-313-11,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-480-11,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-494-11,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-536-11,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-539-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-549-11,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-572-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-590-95,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Blister Pack In 1 Box, Unit-Dose (68084-597-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (68084-597-11)",637,RC,68084-597-01,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-643-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-479-11,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-342-11,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-344-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-346-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-347-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-354-11,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-381-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-389-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-099-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oseltamivir Phosphate: 1 Bottle, Glass In 1 Carton (68180-678-01)  / 60 Ml In 1 Bottle, Glass",637,RC,68180-678-01,NDC,,,facility,both,1,EA,,4.99,4.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
My Way: 1 Blister Pack In 1 Carton (68180-852-11)  / 1 Tablet In 1 Blister Pack,637,RC,68180-852-11,NDC,,,facility,both,1,EA,,24.41,24.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (69097-098-08),637,RC,69097-098-08,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fosfomycin Tromethamine: 1 Dose Pack In 1 Carton (69097-579-67)  / 1 Granule, For Solution In 1 Dose Pack",637,RC,69097-579-67,NDC,,,facility,both,1,EA,,85.43,85.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69097-846-07)",637,RC,69097-846-07,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Acetate: 200 Capsule In 1 Bottle (69097-862-83),637,RC,69097-862-83,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 1 Bottle In 1 Carton (69230-326-01)  / 100 Tablet, Film Coated In 1 Bottle",637,RC,69230-326-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68968-3410-1,NDC,,,facility,both,1,EA,,13.01,13.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (69238-1069-1)",637,RC,69238-1069-1,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)",637,RC,69315-306-15,NDC,,,facility,both,1,EA,,14.69,14.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (69315-904-01),637,RC,69315-904-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (69315-905-01),637,RC,69315-905-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 1000 Tablet In 1 Bottle (69315-905-10),637,RC,69315-905-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,69339-174-02,NDC,,,facility,both,1,EA,,18.58,18.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Doxycycline Hyclate: 50 Capsule In 1 Bottle (69238-1100-2),637,RC,69238-1100-2,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ezetimibe: 30 Tablet In 1 Bottle (69238-1154-3),637,RC,69238-1154-3,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bumetanide: 100 Tablet In 1 Bottle (69238-1489-1),637,RC,69238-1489-1,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5)  / 15 G In 1 Tube,637,RC,69238-1532-5,NDC,,,facility,both,1,EA,,8.15,8.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylergonovine Maleate: 28 Tablet In 1 Bottle (69238-1605-8),637,RC,69238-1605-8,NDC,,,facility,both,1,EA,,23.86,23.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Propranolol Hydrochloride: 100 Tablet In 1 Bottle (69238-2077-1),637,RC,69238-2077-1,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (69238-2512-9)  / 230 Ml In 1 Bottle, Glass",637,RC,69238-2512-9,NDC,,,facility,both,1,EA,,136.42,136.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-257-01)",637,RC,68382-257-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68382-772-30,NDC,,,facility,both,1,EA,,10.42,10.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 500 Tablet In 1 Bottle (68382-805-05),637,RC,68382-805-05,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-806-01),637,RC,68382-806-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68382-771-30,NDC,,,facility,both,1,EA,,5.61,5.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-256-01)",637,RC,68382-256-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68180-877-71,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisinopril: 100 Tablet In 1 Bottle (68180-981-01),637,RC,68180-981-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 15 G In 1 Bottle, Plastic (68308-152-15)",637,RC,68308-152-15,NDC,,,facility,both,1,EA,,8.83,8.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Meloxicam: 100 Tablet In 1 Bottle (68382-051-01),637,RC,68382-051-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)",637,RC,68382-092-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 90 Tablet In 1 Bottle (68382-121-16),637,RC,68382-121-16,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (68382-180-01),637,RC,68382-180-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-333-90),637,RC,68462-333-90,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Indomethacin: 100 Capsule In 1 Bottle (68462-406-01),637,RC,68462-406-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68462-639-25,NDC,,,facility,both,1,EA,,3.76,3.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-330-90),637,RC,68462-330-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Norethindrone Acetate: 50 Tablet In 1 Bottle (68462-304-50),637,RC,68462-304-50,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-260-01)",637,RC,68462-260-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (68462-262-90)",637,RC,68462-262-90,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-292-01)",637,RC,68462-292-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-293-01)",637,RC,68462-293-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxcarbazepine: 1 Bottle, Glass In 1 Carton (69452-125-50)  / 250 Ml In 1 Bottle, Glass",637,RC,69452-125-50,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-046-11,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03)  / 10 Tablet In 1 Blister Pack,637,RC,65649-303-03,NDC,,,facility,both,1,EA,,96.8,96.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02)  / .6 Ml In 1 Vial, Single-Dose",637,RC,65649-551-02,NDC,,,facility,both,1,EA,,272.98,272.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (65862-006-01)",637,RC,65862-006-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cephalexin: 100 Capsule In 1 Bottle (65862-019-01),637,RC,65862-019-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,65862-021-06,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)",637,RC,65862-373-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01),637,RC,65862-419-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Quetiapine Fumarate: 100 Tablet, Film Coated In 1 Bottle (65862-489-01)",637,RC,65862-489-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfamethoxazole And Trimethoprim: 473 Ml In 1 Bottle (65862-496-47),637,RC,65862-496-47,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)",637,RC,65862-503-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (65862-503-20)",637,RC,65862-503-20,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-246-08)",637,RC,65862-246-08,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (65862-096-20)",637,RC,65862-096-20,NDC,,,facility,both,1,EA,,6.75,6.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Finasteride: 90 Tablet, Film Coated In 1 Bottle (65862-149-90)",637,RC,65862-149-90,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Capsule In 1 Bottle (65862-192-01),637,RC,65862-192-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluoxetine: 100 Capsule In 1 Bottle (65862-193-01),637,RC,65862-193-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-201-90)",637,RC,65862-201-90,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-202-90)",637,RC,65862-202-90,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefdinir: 1 Bottle In 1 Carton (65862-218-60)  / 60 Ml In 1 Bottle,637,RC,65862-218-60,NDC,,,facility,both,1,EA,,4.42,4.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-662-01)",637,RC,64896-662-01,NDC,,,facility,both,1,EA,,7.51,7.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (64850-511-01)",637,RC,64850-511-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyridostigmine Bromide: 30 Tablet In 1 Bottle (64980-220-03),637,RC,64980-220-03,NDC,,,facility,both,1,EA,,11.99,11.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-082-03)",637,RC,65162-082-03,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (64850-502-01)",637,RC,64850-502-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydrocortisone: 50 Tablet In 1 Bottle, Plastic (64380-970-25)",637,RC,64380-970-25,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amitiza: 60 Capsule, Gelatin Coated In 1 Bottle (64764-240-60)",637,RC,64764-240-60,NDC,,,facility,both,1,EA,,11.18,11.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)",637,RC,64764-730-30,NDC,,,facility,both,1,EA,,29.5,29.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naproxen: 100 Tablet In 1 Bottle (65162-188-10),637,RC,65162-188-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,65162-791-04,NDC,,,facility,both,1,EA,,3.83,3.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-879-03)",637,RC,65162-879-03,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ad First Aid Multipurpose: 1 Tube In 1 Box (65197-400-10)  / 42.5 G In 1 Tube,637,RC,65197-400-10,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Naproxen: 500 Tablet In 1 Bottle (65162-188-50),637,RC,65162-188-50,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (65162-282-03)",637,RC,65162-282-03,NDC,,,facility,both,1,EA,,3.14,3.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10),637,RC,65162-464-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10),637,RC,65162-465-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10),637,RC,65162-681-10,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Escitalopram Oxalate: 240 Ml In 1 Bottle (65162-705-88),637,RC,65162-705-88,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Extended Release In 1 Bottle (65162-757-10)",637,RC,65162-757-10,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-560-90)",637,RC,65862-560-90,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oscimin: 100 Tablet, Orally Disintegrating In 1 Bottle (68047-253-01)",637,RC,68047-253-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,68084-045-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride Extended-Release: 100 Tablet In 1 Bottle (68001-567-00),637,RC,68001-567-00,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-639-30)",637,RC,67877-639-30,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-198-90),637,RC,67877-198-90,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ibuprofen: 100 Tablet, Film Coated In 1 Bottle (67877-319-01)",637,RC,67877-319-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Linezolid: 1 Blister Pack In 1 Carton (67877-419-33)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,67877-419-33,NDC,,,facility,both,1,EA,,4.99,4.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cefdinir: 60 Capsule In 1 Bottle (67877-543-60),637,RC,67877-543-60,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 100 Tablet In 1 Bottle (67877-589-01),637,RC,67877-589-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-638-30)",637,RC,67877-638-30,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silver Sulfadiazine: 400 G In 1 Jar (67877-124-40),637,RC,67877-124-40,NDC,,,facility,both,1,EA,,94.24,94.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)",637,RC,65862-921-27,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,66553-001-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,66553-002-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,66553-008-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,65862-898-28,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)",637,RC,65862-603-30,NDC,,,facility,both,1,EA,,4.24,4.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azithromycin: 1 Blister Pack In 1 Carton (65862-641-69)  / 6 Tablet, Film Coated In 1 Blister Pack",637,RC,65862-641-69,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Extended Phenytoin Sodium: 1000 Capsule In 1 Bottle (65862-692-99),637,RC,65862-692-99,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 150 Ml In 1 Bottle (65862-707-55),637,RC,65862-707-55,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valganciclovir Hydrochloride: 60 Tablet In 1 Bottle (65862-753-60),637,RC,65862-753-60,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (65862-830-30)",637,RC,65862-830-30,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 100 Tablet, Film Coated In 1 Bottle (65862-859-01)",637,RC,65862-859-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-456-30)",637,RC,66993-456-30,NDC,,,facility,both,1,EA,,22.8,22.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)",637,RC,66993-457-30,NDC,,,facility,both,1,EA,,22.8,22.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)",637,RC,64380-883-04,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)",637,RC,69452-150-20,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,72603-302-01,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 100 Tablet In 1 Bottle (72603-134-01),637,RC,72603-134-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Acyclovir: 100 Capsule In 1 Bottle (72578-002-01),637,RC,72578-002-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,72603-314-01,NDC,,,facility,both,1,EA,,8.29,8.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26),637,RC,72888-125-26,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Package (72888-144-30)",637,RC,72888-144-30,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Tablet In 1 Bottle (72888-152-01),637,RC,72888-152-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Package (72888-175-30)",637,RC,72888-175-30,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,72888-125-15,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (73043-010-03),637,RC,73043-010-03,NDC,,,facility,both,1,EA,,6.53,6.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 30 Tablet In 1 Bottle (72888-178-30),637,RC,72888-178-30,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (72888-114-01),637,RC,72888-114-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nurtec Odt: 1 Blister Pack In 1 Carton (72618-3000-2)  / 8 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,72618-3000-2,NDC,,,facility,both,1,EA,,232.47,232.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tizanidine: 150 Tablet In 1 Bottle, Plastic (72789-325-77)",637,RC,72789-325-77,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,72888-024-06,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-034-01)",637,RC,72888-034-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Coated In 1 Bottle (72888-080-01)",637,RC,72888-080-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-100-30)",637,RC,71699-100-30,NDC,,,facility,both,1,EA,,73.22,73.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xcopri Titration Pack: 1 Kit In 1 Carton (71699-201-28)  *  1 Tablet In 1 Blister Pack *  1 Tablet, Film Coated In 1 Blister Pack",637,RC,71699-201-28,NDC,,,facility,both,1,EA,,7.17,7.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 90 Capsule In 1 Bottle (72205-012-90),637,RC,72205-012-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 60 Capsule In 1 Bottle (72205-040-60),637,RC,72205-040-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dofetilide: 60 Capsule In 1 Bottle (72205-041-60),637,RC,72205-041-60,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pregabalin: 90 Capsule In 1 Bottle (72205-011-90),637,RC,72205-011-90,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Onelax Saline Laxative: 296 Ml In 1 Bottle (71399-0051-1),637,RC,71399-0051-1,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-044-11)  / 10 Capsule In 1 Blister Pack,637,RC,72205-044-11,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-280-60)",637,RC,72205-280-60,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (72241-023-05),637,RC,72241-023-05,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Celecoxib: 100 Capsule In 1 Bottle (72241-024-05),637,RC,72241-024-05,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass",637,RC,73070-100-11,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose Solution: 100 Cup, Unit-Dose In 1 Case (81033-241-51)  / 30 Ml In 1 Cup, Unit-Dose (81033-241-30)",637,RC,81033-241-51,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,77333-827-25,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,80196-291-14,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine 5%: 30 Pouch In 1 Package (82347-0505-5)  / 14 G In 1 Pouch (82347-0505-4),637,RC,82347-0505-5,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,77333-812-25,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Iodide: 30 Ml In 1 Bottle, With Applicator (75834-280-30)",637,RC,75834-280-30,NDC,,,facility,both,1,EA,,5.72,5.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Ella: 1 Blister Pack In 1 Carton (73302-456-01)  / 1 Tablet In 1 Blister Pack,637,RC,73302-456-01,NDC,,,facility,both,1,EA,,67.87,67.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-110-01)",637,RC,73562-110-01,NDC,,,facility,both,1,EA,,7.98,7.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nadolol: 100 Tablet In 1 Bottle (76385-133-01),637,RC,76385-133-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,77333-031-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,77333-049-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nadolol: 100 Tablet In 1 Bottle (76282-347-01),637,RC,76282-347-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (70505-100-10)",637,RC,70505-100-10,NDC,,,facility,both,1,EA,,5.34,5.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Miconazole Nitrate: 1 Tube In 1 Carton (70677-1000-1)  / 30 G In 1 Tube,637,RC,70677-1000-1,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Foster And Thrive Stomach Relief: 1 Bottle In 1 Carton (70677-1082-1)  / 40 Tablet In 1 Bottle,637,RC,70677-1082-1,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1111-1)",637,RC,70677-1111-1,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbinafine Hydrochloride: 1 Tube In 1 Carton (70677-1003-1)  / 30 G In 1 Tube,637,RC,70677-1003-1,NDC,,,facility,both,1,EA,,15.7,15.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tetrabenazine: 112 Tablet In 1 Bottle (70436-102-09),637,RC,70436-102-09,NDC,,,facility,both,1,EA,,7.67,7.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70377-118-31)  / 230 Ml In 1 Bottle, Glass",637,RC,70377-118-31,NDC,,,facility,both,1,EA,,28.68,28.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Bottle, Plastic (70436-036-04)",637,RC,70436-036-04,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Bottle In 1 Carton (69918-101-01)  / 100 Tablet In 1 Bottle,637,RC,69918-101-01,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Senna: 100 Tablet In 1 Bottle (69618-064-01),637,RC,69618-064-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30),637,RC,69918-301-30,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Desmopressin Acetate: 1 Bottle In 1 Carton (69918-201-01)  / 100 Tablet In 1 Bottle,637,RC,69918-201-01,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ethosuximide: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-152-20)",637,RC,69452-152-20,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,69452-156-74,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Progesterone: 100 Capsule In 1 Bottle (69452-233-20),637,RC,69452-233-20,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,69543-451-01,NDC,,,facility,both,1,EA,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (69616-274-30),637,RC,69616-274-30,NDC,,,facility,both,1,EA,,73.92,73.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcium Carbonate 500 Mg: 150 Tablet, Chewable In 1 Bottle, Plastic (69618-020-15)",637,RC,69618-020-15,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01)  / 10 Ml In 1 Bottle,637,RC,70069-051-01,NDC,,,facility,both,1,EA,,27.75,27.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01)  / 5 Ml In 1 Bottle,637,RC,70069-231-01,NDC,,,facility,both,1,EA,,8.29,8.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Tablet, Coated In 1 Bottle (70010-770-01)",637,RC,70010-770-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-030-01)",637,RC,70010-030-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (70010-113-01)",637,RC,70010-113-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",637,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 100 Tablet In 1 Bottle (70010-162-01),637,RC,70010-162-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)",637,RC,70010-491-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Tablet, Coated In 1 Bottle (70010-754-01)",637,RC,70010-754-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa And Levodopa: 30 Tablet In 1 Bottle, Plastic (71205-877-30)",637,RC,71205-877-30,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10),637,RC,70954-496-10,NDC,,,facility,both,1,EA,,165.6,165.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-129-06)",637,RC,70748-129-06,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-130-06)",637,RC,70748-130-06,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fosfomycin Tromethamine: 1 Powder In 1 Packet (70700-268-99),637,RC,70700-268-99,NDC,,,facility,both,1,EA,,145.16,145.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Phytonadione: 1 Bottle In 1 Carton (70710-1014-1)  / 100 Tablet In 1 Bottle,637,RC,70710-1014-1,NDC,,,facility,both,1,EA,,50.84,50.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1159-3)",637,RC,70710-1159-3,NDC,,,facility,both,1,EA,,15.55,15.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1159-9)",637,RC,70710-1159-9,NDC,,,facility,both,1,EA,,15.46,15.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-019-10),637,RC,70954-019-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Prazosin Hydrochloride: 100 Capsule In 1 Bottle (70954-020-10),637,RC,70954-020-10,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle (70954-212-10),637,RC,70954-212-10,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1112-1)",637,RC,70677-1112-1,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (70756-404-11),637,RC,70756-404-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Bottle (70756-703-60)",637,RC,70756-703-60,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lansoprazole: 90 Capsule, Delayed Release In 1 Bottle (70756-807-90)",637,RC,70756-807-90,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (60219-1266-1)  / 10 Capsule In 1 Blister Pack,637,RC,60219-1266-1,NDC,,,facility,both,1,EA,,15.62,15.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tramadol Hydrochloride: 100 Tablet, Coated In 1 Bottle (60219-2348-1)",637,RC,60219-2348-1,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glipizide: 100 Tablet In 1 Bottle (60505-0141-0),637,RC,60505-0141-0,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (60505-0157-1)",637,RC,60505-0157-1,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Misoprostol: 60 Tablet In 1 Bottle (59762-5008-1),637,RC,59762-5008-1,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Misoprostol: 120 Tablet In 1 Bottle (59762-5007-2),637,RC,59762-5007-2,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 100 Tablet In 1 Bottle (59762-0075-1),637,RC,59762-0075-1,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenelzine Sulfate: 60 Tablet, Film Coated In 1 Bottle (59762-0119-1)",637,RC,59762-0119-1,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"ATORVASTATIN CALCIUM: 500 TABLET, FILM COATED in 1 BOTTLE (59762-0158-2) ",637,RC,59762-0158-2,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rifabutin: 100 Capsule In 1 Bottle (59762-1350-1),637,RC,59762-1350-1,NDC,,,facility,both,1,EA,,18.72,18.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
medroxyprogesterone acetate: 1 BOTTLE in 1 CARTON (59762-3742-2)  / 100 TABLET in 1 BOTTLE,637,RC,59762-3742-2,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sulfasalazine: 1 Bottle In 1 Carton (59762-5000-5)  / 100 Tablet In 1 Bottle,637,RC,59762-5000-5,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrocortisone: 100 Tablet In 1 Bottle (59762-0074-1),637,RC,59762-0074-1,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (60505-3110-3)",637,RC,60505-3110-3,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,60505-3113-0,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3250-6)",637,RC,60505-3250-6,NDC,,,facility,both,1,EA,,16.77,16.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3251-6)",637,RC,60505-3251-6,NDC,,,facility,both,1,EA,,6.78,6.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Selegiline Hydrochloride: 60 Tablet In 1 Bottle (60505-3438-3),637,RC,60505-3438-3,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Guanfacine Extended-Release: 100 Tablet, Extended Release In 1 Bottle (60505-3927-1)",637,RC,60505-3927-1,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4642-3)",637,RC,60505-4642-3,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4643-3)",637,RC,60505-4643-3,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3276-0)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,60505-3276-0,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2671-9)",637,RC,60505-2671-9,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0165-1),637,RC,60505-0165-1,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate: 1 Bottle, Spray In 1 Carton (60505-0829-1)  / 120 Spray, Metered In 1 Bottle, Spray",637,RC,60505-0829-1,NDC,,,facility,both,1,EA,,32.56,32.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2578-9)",637,RC,60505-2578-9,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (60505-2579-9)",637,RC,60505-2579-9,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle (60505-2656-1),637,RC,60505-2656-1,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Bupropion Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (60505-0158-1)",637,RC,60505-0158-1,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyvanse: 100 Capsule In 1 Bottle (59417-101-10),637,RC,59417-101-10,NDC,,,facility,both,1,EA,,23.36,23.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vyvanse: 100 Capsule In 1 Bottle (59417-103-10),637,RC,59417-103-10,NDC,,,facility,both,1,EA,,23.33,23.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (59651-026-55),637,RC,59651-026-55,NDC,,,facility,both,1,EA,,5.55,5.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (59651-214-30)  / 200 Spray, Metered In 1 Bottle, Spray",637,RC,59651-214-30,NDC,,,facility,both,1,EA,,26.05,26.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Propafenone Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (59651-256-01)",637,RC,59651-256-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycontin: 2 Blister Pack In 1 Carton (59011-440-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,59011-440-20,NDC,,,facility,both,1,EA,,30.52,30.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rexulti: 1 Bottle In 1 Carton (59148-035-13)  / 30 Tablet In 1 Bottle,637,RC,59148-035-13,NDC,,,facility,both,1,EA,,91.32,91.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Rexulti: 1 Bottle In 1 Carton (59148-037-13)  / 30 Tablet In 1 Bottle,637,RC,59148-037-13,NDC,,,facility,both,1,EA,,90.65,90.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,59385-022-01,NDC,,,facility,both,1,EA,,12.9,12.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clobazam: 1 Bottle In 1 Carton (59651-401-12)  / 120 Ml In 1 Bottle,637,RC,59651-401-12,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Risperidone: 7 Blister Pack In 1 Carton (59746-020-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,59746-020-22,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Colchicine: 100 Tablet In 1 Bottle (59651-455-01),637,RC,59651-455-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01),637,RC,59651-457-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonazepam: 100 Tablet In 1 Bottle (59651-722-01),637,RC,59651-722-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)",637,RC,59676-278-01,NDC,,,facility,both,1,EA,,89.37,89.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Prezcobix: 30 Tablet, Film Coated In 1 Bottle (59676-575-30)",637,RC,59676-575-30,NDC,,,facility,both,1,EA,,147.95,147.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,59011-410-20,NDC,,,facility,both,1,EA,,9.74,9.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-387-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-390-11,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-406-40,NDC,,,facility,both,1,EA,,12.66,12.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-428-11,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-437-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-443-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-325-11,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-333-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-345-11,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-349-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-369-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-446-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-447-11,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-486-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-487-11,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-495-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-506-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-508-11,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-519-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-544-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-497-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-484-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-450-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-453-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-454-11,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-461-11,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-464-11,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-473-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-484-01)  / 1 Capsule In 1 Blister Pack (60687-484-11)",637,RC,60687-484-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-292-11,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cyclosporine: 60 Vial In 1 Tray (60505-6202-2)  / .4 Ml In 1 Vial,637,RC,60505-6202-2,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60505-7061-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60505-7062-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60505-7063-0,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-100-11,NDC,,,facility,both,1,EA,,5.96,5.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-105-11,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-113-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-206-11,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-217-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-230-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-231-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-234-11,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-249-40,NDC,,,facility,both,1,EA,,6.93,6.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-256-11,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-195-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-152-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-155-11,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cephalexin: 100 Blister Pack In 1 Box, Unit-Dose (60687-163-01)  / 1 Capsule In 1 Blister Pack (60687-163-11)",637,RC,60687-163-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-163-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01)  / .5 Ml In 1 Vial, Single-Dose",637,RC,55150-173-01,NDC,,,facility,both,1,EA,,6.93,6.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tizanidine: 150 Tablet In 1 Bottle (55111-179-15),637,RC,55111-179-15,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 500 Tablet, Film Coated In 1 Bottle (55111-196-05)",637,RC,55111-196-05,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 90 Tablet, Film Coated In 1 Bottle (55111-196-90)",637,RC,55111-196-90,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-262-79)",637,RC,55111-262-79,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-263-79)",637,RC,55111-263-79,NDC,,,facility,both,1,EA,,4.51,4.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Spironolactone: 100 Tablet In 1 Bottle (53746-511-01),637,RC,53746-511-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Bethanechol Chloride: 100 Tablet In 1 Bottle (53746-571-01),637,RC,53746-571-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle, Plastic (54838-502-80)",637,RC,54838-502-80,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-466-01)",637,RC,55111-466-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-467-01)",637,RC,55111-467-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-468-01)",637,RC,55111-468-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Extended Release In 1 Bottle (55111-533-01)",637,RC,55111-533-01,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,55111-671-06,NDC,,,facility,both,1,EA,,37.54,37.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Montelukast Sodium: 90 Tablet, Coated In 1 Bottle (55111-725-90)",637,RC,55111-725-90,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle (55111-734-90)",637,RC,55111-734-90,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dibucaine: 1 Tube In 1 Box (57896-131-01)  / 28 G In 1 Tube,637,RC,57896-131-01,NDC,,,facility,both,1,EA,,7.14,7.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Stool Softener: 100 Capsule, Liquid Filled In 1 Bottle (57896-401-01)",637,RC,57896-401-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,57896-490-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (57664-808-88)",637,RC,57664-808-88,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (57237-058-60)",637,RC,57237-058-60,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Modafinil: 30 Tablet In 1 Bottle (57237-155-30),637,RC,57237-155-30,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Glycerin Children: 5 Blister Pack In 1 Carton (57237-326-52)  / 5 Suppository In 1 Blister Pack (57237-326-51),637,RC,57237-326-52,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Tramadol Hydrochloride: 100 Tablet In 1 Bottle (57664-377-08),637,RC,57664-377-08,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (57664-378-88),637,RC,57664-378-88,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Geri-Lanta Antacid Antigas: 355 Ml In 1 Bottle (57896-629-12),637,RC,57896-629-12,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40)  / 5 Ml In 1 Bottle, Plastic",637,RC,58602-006-40,NDC,,,facility,both,1,EA,,13.74,13.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loratadine: 1 Blister Pack In 1 Carton (58602-702-83)  / 10 Tablet In 1 Blister Pack,637,RC,58602-702-83,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
M-Dryl: 473 Ml In 1 Bottle (58657-528-16),637,RC,58657-528-16,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ciprofloxacin: 100 Tablet, Coated In 1 Bottle (58657-675-01)",637,RC,58657-675-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Theratears: 6 Pouch In 1 Carton (58790-003-30)  / 5 Vial In 1 Pouch / .6 Ml In 1 Vial,637,RC,58790-003-30,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adult Low Dose Enteric Coated Aspirin: 1000 Tablet, Coated In 1 Bottle (57896-981-10)",637,RC,57896-981-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Adult Low Dose Enteric Coated Aspirin: 120 Tablet, Coated In 1 Bottle (57896-981-12)",637,RC,57896-981-12,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,55566-6500-1,NDC,,,facility,both,1,EA,,26.65,26.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-800-60)",637,RC,55513-800-60,NDC,,,facility,both,1,EA,,18.59,18.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-810-60)",637,RC,55513-810-60,NDC,,,facility,both,1,EA,,18.26,18.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10)  / 10 Tablet In 1 Blister Pack",637,RC,63739-544-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10)  / 10 Capsule In 1 Blister Pack",637,RC,63739-567-10,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10)  / 10 Tablet In 1 Blister Pack",637,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Polyethylene Glycol 3350: 100 Packet In 1 Carton (63739-760-04)  / 17 G In 1 Packet (63739-760-01),637,RC,63739-760-04,NDC,,,facility,both,1,EA,,2.77,2.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10)  / 10 Capsule In 1 Blister Pack,637,RC,63739-902-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10)  / 10 Capsule In 1 Blister Pack,637,RC,63739-903-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,63739-760-01,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Aspirin Chewable: 30 Blister Pack In 1 Box (63739-434-02)  / 10 Tablet In 1 Blister Pack,637,RC,63739-434-02,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,63739-159-77,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 5 Ml In 1 Cup, Unit-Dose (63739-160-70)",637,RC,63739-160-70,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clopidogrel Bisulfate: 5 Blister Pack In 1 Carton (63739-178-30)  / 6 Tablet, Film Coated In 1 Blister Pack",637,RC,63739-178-30,NDC,,,facility,both,1,EA,,19.99,19.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,63739-193-72,NDC,,,facility,both,1,EA,,14.82,14.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02)  / 10 Tablet, Coated In 1 Blister Pack",637,RC,63739-212-02,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gas Relief: 30 Blister Pack In 1 Box (63739-225-02)  / 10 Tablet, Chewable In 1 Blister Pack",637,RC,63739-225-02,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-236-10)  / 10 CAPSULE in 1 BLISTER PACK",637,RC,63739-236-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10)  / 10 Capsule In 1 Blister Pack,637,RC,63739-904-10,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Sodium Sulfate, Potassium Sulfate And Magnesium Sulfate Oral: 2 Bottle In 1 Carton (64380-116-01)  / 177 Ml In 1 Bottle (64380-116-02)",637,RC,64380-116-01,NDC,,,facility,both,1,EA,,123.51,123.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)",637,RC,64380-737-06,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (64380-741-06),637,RC,64380-741-06,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Polyethylene Glycol 3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride With Lemon Flavor: 4 L In 1 Jug (64380-769-21)",637,RC,64380-769-21,NDC,,,facility,both,1,EA,,70.56,70.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-797-01),637,RC,64380-797-01,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-963-10)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,63739-963-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,63739-976-01,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10)  / 10 CAPSULE in 1 BLISTER PACK",637,RC,63739-984-10,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,63739-158-70,NDC,,,facility,both,1,EA,,4.94,4.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-005-32)  / 10 Capsule In 1 Blister Pack",637,RC,63739-005-32,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-047-10)  / 10 TABLET in 1 BLISTER PACK",637,RC,63739-047-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-048-10)  / 10 TABLET in 1 BLISTER PACK",637,RC,63739-048-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midodrine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-145-10)  / 10 Tablet In 1 Blister Pack",637,RC,63739-145-10,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-549-11,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-868-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Docosanol: 1 Tube In 1 Package (61269-981-35)  / 2 G In 1 Tube,637,RC,61269-981-35,NDC,,,facility,both,1,EA,,19.13,19.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-836-11,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-725-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-730-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-742-11,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-746-11,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-756-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-775-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-810-11,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-722-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silvadene: 50 G In 1 Jar (61570-131-50),637,RC,61570-131-50,NDC,,,facility,both,1,EA,,15.98,15.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,61874-115-11,NDC,,,facility,both,1,EA,,90.97,90.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Silvadene: 400 G In 1 Jar (61570-131-40),637,RC,61570-131-40,NDC,,,facility,both,1,EA,,65.18,65.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"100 TABLET in 1 BOTTLE, PLASTIC (61442-127-01) ",637,RC,61442-127-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-579-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-580-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-583-11,NDC,,,facility,both,1,EA,,4.87,4.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-586-11,NDC,,,facility,both,1,EA,,3.37,3.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-587-11,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-590-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-591-11,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-593-11,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-576-03,NDC,,,facility,both,1,EA,,5.34,5.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-550-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-555-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-556-33,NDC,,,facility,both,1,EA,,12.55,12.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-558-11,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methocarbamol: 100 Blister Pack In 1 Box, Unit-Dose (60687-559-01)  / 1 Tablet In 1 Blister Pack (60687-559-11)",637,RC,60687-559-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-559-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-568-11,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-598-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-661-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-680-11,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-681-11,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-690-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-693-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-704-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-711-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Genvoya: 30 Tablet In 1 Bottle, Plastic (61958-1901-1)",637,RC,61958-1901-1,NDC,,,facility,both,1,EA,,239.85,239.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-602-11,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-607-11,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-612-11,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-629-11,NDC,,,facility,both,1,EA,,5.84,5.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01)  / 1 Tablet In 1 Blister Pack (60687-631-11)",637,RC,60687-631-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-633-11,NDC,,,facility,both,1,EA,,5.32,5.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-656-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,60687-657-11,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)",637,RC,61958-2002-1,NDC,,,facility,both,1,EA,,131.99,131.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Midazolam Hydrochloride: 118 mL in 1 BOTTLE, GLASS (63304-205-18) ",637,RC,63304-205-18,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clindamycin Hydrochloride: 100 Capsule In 1 Bottle (63304-692-01),637,RC,63304-692-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lorazepam: 100 Tablet In 1 Bottle (63304-772-01),637,RC,63304-772-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)",637,RC,62756-797-88,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fycompa: 30 Tablet In 1 Bottle (62856-272-30),637,RC,62856-272-30,NDC,,,facility,both,1,EA,,35.31,35.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 100 Ml In 1 Bottle (62135-712-42),637,RC,62135-712-42,NDC,,,facility,both,1,EA,,5.91,5.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nifedipine: 100 Tablet, Film Coated, Extended Release In 1 Bottle (62175-262-37)",637,RC,62175-262-37,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-310-37)",637,RC,62175-310-37,NDC,,,facility,both,1,EA,,5.96,5.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (62135-502-47),637,RC,62135-502-47,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-365-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,62332-365-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-366-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,62332-366-06,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Clonazepam: 60 Blister Pack In 1 Carton (62332-367-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,62332-367-06,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oseltamivir: 1 Carton In 1 Blister Pack (62332-415-10)  / 10 Capsule In 1 Carton,637,RC,62332-415-10,NDC,,,facility,both,1,EA,,14.46,14.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amantadine: 100 Capsule In 1 Bottle (62332-246-31),637,RC,62332-246-31,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cartia Xt: 90 Capsule, Extended Release In 1 Bottle (62037-598-90)",637,RC,62037-598-90,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)",637,RC,61958-2501-1,NDC,,,facility,both,1,EA,,248.89,248.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Biktarvy: 30 Tablet In 1 Blister Pack (61958-2501-3),637,RC,61958-2501-3,NDC,,,facility,both,1,EA,,253.94,253.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (62559-390-20)  / 10 Capsule In 1 Blister Pack,637,RC,62559-390-20,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (62559-390-50),637,RC,62559-390-50,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Terbutaline Sulfate: 100 Tablet In 1 Bottle (62559-722-01),637,RC,62559-722-01,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,62584-897-11,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,62584-984-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,62584-994-11,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Propafenone Hydrochloride: 100 Tablet, Coated In 1 Bottle (62559-231-01)",637,RC,62559-231-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-496-30)",637,RC,62332-496-30,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,62559-157-17,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Reglan: 100 Tablet In 1 Bottle, Plastic (62559-166-01)",637,RC,62559-166-01,NDC,,,facility,both,1,EA,,6.77,6.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
COUMADIN: 1 BOTTLE in 1 CARTON (0056-0170-70)  / 100 TABLET in 1 BOTTLE,637,RC,0056-0170-70,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Genteal Tears Night-Time: 1 Tube In 1 Carton (0065-0518-01)  / 3.5 G In 1 Tube,637,RC,0065-0518-01,NDC,,,facility,both,1,EA,,13.59,13.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25)  / 10 Tablet In 1 Blister Pack,637,RC,0054-8297-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25)  / 10 Tablet In 1 Blister Pack,637,RC,0054-8299-25,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Furosemide: 10 Blister Pack In 1 Carton (0054-8301-25)  / 10 Tablet In 1 Blister Pack,637,RC,0054-8301-25,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)",637,RC,0054-8526-25,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Xeljanz: 60 Tablet, Film Coated In 1 Bottle (0069-1001-01)",637,RC,0069-1001-01,NDC,,,facility,both,1,EA,,182.94,182.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0069-5045-06,NDC,,,facility,both,1,EA,,90.11,90.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5317-20)  / 1 Kit In 1 Blister Pack (0069-5317-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-2085-11)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",637,RC,0069-5317-20,NDC,,,facility,both,1,EA,,135.19,135.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0069-5321-03,NDC,,,facility,both,1,EA,,87.51,87.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30)  / 1 Kit In 1 Blister Pack (0069-5321-03)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",637,RC,0069-5321-30,NDC,,,facility,both,1,EA,,90.61,90.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Propranolol Hydrochloride: 500 Ml In 1 Bottle, Plastic (0054-3727-63)",637,RC,0054-3727-63,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21)  / 30 G In 1 Tube, With Applicator",637,RC,0046-0872-21,NDC,,,facility,both,1,EA,,819.99,819.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0010-20)  / 1 Tablet In 1 Blister Pack,637,RC,0054-0010-20,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0010-25),637,RC,0054-0010-25,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Flecainide Acetate: 60 Tablet In 1 Bottle (0054-0011-21),637,RC,0054-0011-21,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Restasis: 30 Vial, Single-Use In 1 Tray (0023-9163-30)  / .4 Ml In 1 Vial, Single-Use",637,RC,0023-9163-30,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)",637,RC,0032-0045-70,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-2636-01)",637,RC,0032-2636-01,NDC,,,facility,both,1,EA,,16.17,16.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)",637,RC,0032-3016-13,NDC,,,facility,both,1,EA,,24.55,24.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Proctofoam Hc: 1 Canister In 1 Carton (0037-6822-10)  / 10 G In 1 Canister,637,RC,0037-6822-10,NDC,,,facility,both,1,EA,,334.43,334.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dicyclomine Hydrochloride: 473 Ml In 1 Bottle (0054-0622-63),637,RC,0054-0622-63,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0054-0660-25),637,RC,0054-0660-25,NDC,,,facility,both,1,EA,,6.51,6.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0709-20)  / 100 Tablet In 1 Blister Pack,637,RC,0054-0709-20,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Capsule, Gelatin Coated In 1 Bottle (0054-2527-25)",637,RC,0054-2527-25,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Calcitriol: 1 Bottle, Glass In 1 Carton (0054-3120-41)  / 15 Ml In 1 Bottle, Glass",637,RC,0054-3120-41,NDC,,,facility,both,1,EA,,6.39,6.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99)  / 120 Spray, Metered In 1 Bottle, Glass",637,RC,0054-3270-99,NDC,,,facility,both,1,EA,,15.34,15.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Posaconazole: 1 Bottle, Glass In 1 Carton (0054-0449-49)  / 105 Ml In 1 Bottle, Glass",637,RC,0054-0449-49,NDC,,,facility,both,1,EA,,115.99,115.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle, Plastic (0054-0021-25)",637,RC,0054-0021-25,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63),637,RC,0054-0237-63,NDC,,,facility,both,1,EA,,2.26,2.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24)  / 10 Tablet In 1 Blister Pack,637,RC,0054-0243-24,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1000 Ml In 1 Bottle (0054-0391-68),637,RC,0054-0391-68,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lactulose: 30 Ml In 1 Cup, Unit-Dose (0116-4005-30)",637,RC,0116-4005-30,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",637,RC,0121-0431-30,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0489-05,NDC,,,facility,both,1,EA,,7.3,7.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Haloperidol: 10 Tray In 1 Case (0121-0581-05)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose",637,RC,0121-0581-05,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0638-05,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Amantadine Hydrochloride: 10 Tray In 1 Case (0121-0646-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",637,RC,0121-0646-10,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Valproic Acid: 473 Ml In 1 Bottle (0121-0675-85),637,RC,0121-0675-85,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Calcium Carbonate: 12 Bottle In 1 Case (0121-0766-16)  / 473 Ml In 1 Bottle,637,RC,0121-0766-16,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Chlorhexidine Gluconate: 473 Ml In 1 Bottle (0116-2001-16),637,RC,0116-2001-16,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-7295-01)",637,RC,0093-7295-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 500 Tablet, Film Coated In 1 Bottle (0093-7296-05)",637,RC,0093-7296-05,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (0093-7385-98)",637,RC,0093-7385-98,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Venlafaxine Hydrochloride: 100 Tablet In 1 Bottle (0093-9147-01),637,RC,0093-9147-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pyridostigmine Bromide: 100 Tablet In 1 Bottle (0115-3511-01),637,RC,0115-3511-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dantrolene Sodium: 100 Capsule In 1 Bottle (0115-4411-01),637,RC,0115-4411-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle, Plastic (0115-9920-01)",637,RC,0115-9920-01,NDC,,,facility,both,1,EA,,4.98,4.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 1 Bottle, Dropper In 1 Carton (0121-0770-01)  / 30 Ml In 1 Bottle, Dropper",637,RC,0121-0770-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lacosamide: 1 Tray In 1 Case (0121-1012-95)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1012-05)",637,RC,0121-1012-95,NDC,,,facility,both,1,EA,,45.58,45.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1016-05,NDC,,,facility,both,1,EA,,44.59,44.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1154-30,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1488-10,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",637,RC,0121-1576-10,NDC,,,facility,both,1,EA,,4.39,4.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",637,RC,0121-1761-30,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mag-Al Plus Xs: 10 Tray In 1 Case (0121-1762-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",637,RC,0121-1762-30,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1775-05,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Childrens Acetaminophen: 10 Tray In 1 Case (0121-1781-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1781-05)",637,RC,0121-1781-00,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1012-05,NDC,,,facility,both,1,EA,,45.52,45.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0868-05,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0904-05,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0905-05,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0914-05,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0917-05,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Potassium Chloride: 473 Ml In 1 Bottle (0121-0948-16),637,RC,0121-0948-16,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Lidocaine Hydrochloride: 12 Bottle In 1 Case (0121-0950-03)  / 100 Ml In 1 Bottle,637,RC,0121-0950-03,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-0974-10,NDC,,,facility,both,1,EA,,10.4,10.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Noxafil: 1 Bottle, Glass In 1 Carton (0085-1328-01)  / 105 Ml In 1 Bottle, Glass",637,RC,0085-1328-01,NDC,,,facility,both,1,EA,,170.36,170.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0051-01)",637,RC,0093-0051-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01),637,RC,0093-0053-01,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0135-01)",637,RC,0093-0135-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)",637,RC,0078-0777-20,NDC,,,facility,both,1,EA,,20.72,20.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Synthroid: 1000 Tablet In 1 Bottle (0074-4341-19),637,RC,0074-4341-19,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11)  / 10 Tablet In 1 Blister Pack",637,RC,0074-7148-11,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)",637,RC,0078-0659-20,NDC,,,facility,both,1,EA,,20.82,20.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0696-20)",637,RC,0078-0696-20,NDC,,,facility,both,1,EA,,21.04,21.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Loperamide Hydrochloride: 100 Capsule In 1 Bottle (0093-0311-01),637,RC,0093-0311-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),637,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),637,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Dicloxacillin Sodium: 100 Capsule In 1 Bottle (0093-3123-01),637,RC,0093-3123-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",637,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3426-01)",637,RC,0093-3426-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lorazepam: 1000 Tablet In 1 Bottle, Plastic (0093-3426-10)",637,RC,0093-3426-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cephalexin: 100 Ml In 1 Bottle (0093-4177-73),637,RC,0093-4177-73,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0093-5245-19,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Liothyronine Sodium: 100 Tablet In 1 Bottle (0093-2179-01),637,RC,0093-2179-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0318-01)",637,RC,0093-0318-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pravastatin Sodium: 90 Tablet In 1 Bottle (0093-0771-98),637,RC,0093-0771-98,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0810-01),637,RC,0093-0810-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 500 Capsule In 1 Bottle (0093-0810-05),637,RC,0093-0810-05,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Rinvoq: 30 Tablet, Extended Release In 1 Bottle (0074-2306-30)",637,RC,0074-2306-30,NDC,,,facility,both,1,EA,,406.82,406.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01),637,RC,0093-0812-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Sotalol Hydrochloride: 100 Tablet In 1 Bottle (0093-1061-01),637,RC,0093-1061-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Cilostazol: 60 Tablet In 1 Bottle (0093-2064-06),637,RC,0093-2064-06,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01),637,RC,0093-0811-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5026886011,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5483800650,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5789645101,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5789687503,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5865717001,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5026885911,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,4110081163,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,4203710478,NDC,,,facility,both,1,EA,,9.58,9.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,4329255857,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,4601701816,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5026818311,NDC,,,facility,both,1,EA,,4.74,4.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5026852411,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5026885311,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,5026885811,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6936722001,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6936725001,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6936726701,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6961807059,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7214045231,NDC,,,facility,both,1,EA,,9.33,9.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7583401060,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7733393810,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6817600011,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6025800615,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6025816001,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6253000011,NDC,,,facility,both,1,EA,,7.11,7.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6332325410,NDC,,,facility,both,1,EA,,38.06,38.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6373612002,NDC,,,facility,both,1,EA,,14.23,14.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6498010401,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6498033901,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,6498033990,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,3660219209,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,536440601,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,536730001,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,573475652,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,574030416,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,574031116,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904052360,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904052361,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,536134480,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,87040501,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,87086644,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,121067616,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,121119030,NDC,,,facility,both,1,EA,,7.65,7.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,132030140,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,225055050,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,395266116,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,486112501,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904053061,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,2055500100,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,2055501900,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,2055502700,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,2055503300,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,2055503601,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,2159934562,NDC,,,facility,both,1,EA,,3.01,3.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,3010304000,NDC,,,facility,both,1,EA,,4.03,4.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,3010304600,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,3172213747,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,1093995959,NDC,,,facility,both,1,EA,,3.37,3.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904522452,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904582493,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904598463,NDC,,,facility,both,1,EA,,8.63,8.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904719106,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904759160,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,904759161,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7733393825,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0277-31)",637,RC,0006-0277-31,NDC,,,facility,both,1,EA,,19.89,19.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)",637,RC,0006-3069-01,NDC,,,facility,both,1,EA,,106.08,106.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Refresh Celluvisc: 30 Vial, Single-Use In 1 Carton (0023-4554-30)  / .4 Ml In 1 Vial, Single-Use",637,RC,0023-4554-30,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Refresh Lacri-Lube: 1 Tube In 1 Carton (0023-0312-04)  / 3.5 G In 1 Tube,637,RC,0023-0312-04,NDC,,,facility,both,1,EA,,19.15,19.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8068116900,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8380007906,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,97344038787,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8068115500,NDC,,,facility,both,1,EA,,3.74,3.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7733394810,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7733395125,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,7733398325,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8068104900,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8068109700,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8068109800,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,8068110000,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0006-0112-01,NDC,,,facility,both,1,EA,,19.89,19.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-0050-60)",637,RC,0003-0050-60,NDC,,,facility,both,1,EA,,55.73,55.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0006-0221-01,NDC,,,facility,both,1,EA,,19.89,19.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0003-0894-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0003-0893-31,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1781-05,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1805-77)",637,RC,0378-1805-77,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1809-77)",637,RC,0378-1809-77,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1811-77)",637,RC,0378-1811-77,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1813-77)",637,RC,0378-1813-77,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Spironolactone: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-2146-01)",637,RC,0378-2146-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fenofibrate: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-3066-77)",637,RC,0378-3066-77,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Paliperidone: 30 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (0378-3980-93) ",637,RC,0378-3980-93,NDC,,,facility,both,1,EA,,44.32,44.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Abacavir Sulfate: 1 Bottle, Plastic In 1 Carton (0378-4105-91)  / 60 Tablet, Film Coated In 1 Bottle, Plastic",637,RC,0378-4105-91,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1800-77)",637,RC,0378-1800-77,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5813-77)",637,RC,0378-5813-77,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Buspirone Hydrochloride: 500 Tablet In 1 Bottle, Plastic (0378-1150-05)",637,RC,0378-1150-05,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 500 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-05)",637,RC,0378-0018-05,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0047-01)",637,RC,0378-0047-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Chlorthalidone: 100 Tablet In 1 Bottle, Plastic (0378-0222-01)",637,RC,0378-0222-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-0771-01) ",637,RC,0378-0771-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-0871-16,NDC,,,facility,both,1,EA,,23.96,23.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-0872-16,NDC,,,facility,both,1,EA,,38.91,38.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-0873-16,NDC,,,facility,both,1,EA,,52.33,52.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)",637,RC,0378-0018-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-9122-16,NDC,,,facility,both,1,EA,,18.32,18.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Benzoin Compound Tincture: 59 Ml In 1 Bottle, Plastic (0395-0243-92)",637,RC,0395-0243-92,NDC,,,facility,both,1,EA,,7.98,7.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0395-1031-16,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0395-1031-96,NDC,,,facility,both,1,EA,,4.25,4.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)",637,RC,0406-0527-10,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),637,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1142-01),637,RC,0406-1142-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Naltrexone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (0406-1170-03)",637,RC,0406-1170-03,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5815-77)",637,RC,0378-5815-77,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-6470-16,NDC,,,facility,both,1,EA,,33.22,33.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-8760-98,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-8768-16,NDC,,,facility,both,1,EA,,11.49,11.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-9104-16,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0378-9112-16,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01),637,RC,0406-1236-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01),637,RC,0406-3243-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01),637,RC,0406-3244-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23),637,RC,0406-5771-23,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)",637,RC,0406-8315-23,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)",637,RC,0406-8330-23,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8510-23),637,RC,0406-8510-23,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8515-23),637,RC,0406-8515-23,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Mixed Salts Of A Single Entity Amphetamine Product Xr: 100 Capsule, Extended Release In 1 Bottle (0406-8951-01)",637,RC,0406-8951-01,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Temazepam: 100 Capsule In 1 Bottle (0406-9961-01),637,RC,0406-9961-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Amoxicillin: 100 Ml In 1 Bottle (0143-9889-01),637,RC,0143-9889-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0003-15)  / 15 G In 1 Tube,637,RC,0168-0003-15,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0004-15)  / 15 G In 1 Tube,637,RC,0168-0004-15,NDC,,,facility,both,1,EA,,4.77,4.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60),637,RC,0172-2089-60,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Diazepam: 100 Tablet In 1 Bottle (0172-3925-60),637,RC,0172-3925-60,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Triamcinolone Acetonide: 80 G In 1 Tube (0168-0006-80),637,RC,0168-0006-80,NDC,,,facility,both,1,EA,,12.24,12.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Betamethasone Valerate: 45 G In 1 Tube (0168-0033-46),637,RC,0168-0033-46,NDC,,,facility,both,1,EA,,34.49,34.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin N: 1 Vial In 1 Carton (0169-1834-11)  / 10 Ml In 1 Vial,637,RC,0169-1834-11,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Novolin 70/30: 1 Vial In 1 Carton (0169-1837-11)  / 10 Ml In 1 Vial,637,RC,0169-1837-11,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Tresiba: 1 Vial, Glass In 1 Carton (0169-2662-11)  / 10 Ml In 1 Vial, Glass",637,RC,0169-2662-11,NDC,,,facility,both,1,EA,,13.12,13.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass",637,RC,0169-7501-11,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Fleet: 12 SUPPOSITORY in 1 JAR (0132-0079-12) ,637,RC,0132-0079-12,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pedia-Lax: 12 Suppository In 1 Jar (0132-0081-12),637,RC,0132-0081-12,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)",637,RC,0132-0201-40,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Pedia-Lax: 66 Ml In 1 Bottle, With Applicator (0132-0202-20)",637,RC,0132-0202-20,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Captopril: 100 Tablet In 1 Bottle (0143-1171-01),637,RC,0143-1171-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Doxycycline Hyclate: 50 Capsule, Gelatin Coated In 1 Bottle, Plastic (0143-3142-50)",637,RC,0143-3142-50,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Vimpat: 6 Blister Pack In 1 Carton (0131-2479-60)  / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0131-2479-60,NDC,,,facility,both,1,EA,,38.52,38.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1870-10,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-1882-11,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-4675-05,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Nystatin: 4 TRAY in 1 CASE (0121-4785-05)  / 10 CUP, UNIT-DOSE in 1 TRAY / 5 mL in 1 CUP, UNIT-DOSE",637,RC,0121-4785-05,NDC,,,facility,both,1,EA,,8.89,8.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-4799-05,NDC,,,facility,both,1,EA,,4.22,4.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-4827-05,NDC,,,facility,both,1,EA,,7.41,7.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-4950-15,NDC,,,facility,both,1,EA,,7.99,7.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0121-4967-05,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (0185-0122-01),637,RC,0185-0122-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Methimazole: 100 TABLET in 1 BOTTLE (0185-0210-01) ,637,RC,0185-0210-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0310-1110-01,NDC,,,facility,both,1,EA,,15.94,15.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0310-1105-01,NDC,,,facility,both,1,EA,,10.24,10.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Nitro-Bid: 48 Packet In 1 Box (0281-0326-08)  / 1 G In 1 Packet,637,RC,0281-0326-08,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2128-10),637,RC,0228-2128-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 60 Capsule, Delayed Release Pellets In 1 Bottle (0228-2890-06)",637,RC,0228-2890-06,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)",637,RC,0228-2891-03,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)",637,RC,0228-2892-03,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pacerone: 30 Tablet In 1 Bottle (0245-0144-30),637,RC,0245-0144-30,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0245-0144-89,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Pacerone: 100 Blister Pack In 1 Carton (0245-0147-01)  / 1 Tablet In 1 Blister Pack (0245-0147-89),637,RC,0245-0147-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0245-0147-89,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10),637,RC,0228-2127-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0211-11),637,RC,0245-0211-11,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0185-0842-01)",637,RC,0185-0842-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39)  / 10 Tablet In 1 Blister Pack",637,RC,0186-0777-39,NDC,,,facility,both,1,EA,,13.87,13.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0223-1760-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Neo-Synephrine Mild: 15 Ml In 1 Bottle, Spray (0225-0800-47)",637,RC,0225-0800-47,NDC,,,facility,both,1,EA,,6.7,6.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
Alprazolam: 100 Tablet In 1 Bottle (0228-2031-10),637,RC,0228-2031-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0245-0212-89,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con: 100 Blister Pack In 1 Blister Pack (0245-5316-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (0245-5316-89)",637,RC,0245-5316-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0245-5316-89,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Klor-Con M: 500 Tablet, Extended Release In 1 Bottle (0245-5319-15)",637,RC,0245-5319-15,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3028-02)",637,RC,0254-3028-02,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3029-02)",637,RC,0254-3029-02,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0254-3012-78,NDC,,,facility,both,1,EA,,212.34,212.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA
NDC Description Not Available,637,RC,0245-5319-89,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA